To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of... more To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability. Longitudinal mixed methods approach. Four sites across Canada. 347 patients with breast cancer 6-12 months after surgery at first point of data collection. Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed. Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals. Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability. Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.
Introduction: Most longitudinal breast cancer studies have found that treatment-related sequelae ... more Introduction: Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity [lymphedema, pain and range of motion (ROM) restrictions] can have a significant impact on quality of life. In a previous study, we found that 6-12 months after breast cancer surgery, 49% of participants had difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with participation in recreation. Methods: A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-breast cancer surgery. Results: Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p<0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery, with pain accounting for the greatest proportion of variance. Discussion/conclusion: Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits. Implications for cancer survivors: Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Journal of Prevention & Intervention in The Community, 2008
Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treat... more Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treating depressed patients. Interview transcripts were analyzed thematically with respect to physicians' understanding of women's depression and their treatment strategies with depressed women. Stress arising in the social context of women's lives was perceived as a key precipitant of depression in women, with family-related, gender-specific and practical sources of stress as the main contributors. Physicians' treatment strategies had the aims of alleviating depressive symptoms and stress reduction. Implications of the findings for primary health care delivery and community-based interventions with depressed women are discussed.
Introduction A Canadian research team is conducting a multi-centered, non-interventional national... more Introduction A Canadian research team is conducting a multi-centered, non-interventional national study with the objective of charting the course of arm morbidity after breast cancer surgery. This paper examined the relationship between arm morbidity and leisure and recreational activities of affected women. Methods Five hundred and forty seven women with stage I-III breast cancer were recruited in four centers across Canada: Surrey (BC); Winnipeg (MB), Montreal (QB) and Fredericton (NB). Participants were enrolled in the study 6–12 months post surgery. Physical examination was used to assess arm and shoulder functioning and questionnaires were used to assess disability, pain, and participation in recreational and leisure activities. Results At the first clinical assessment (T1), the mean number of months post breast cancer surgery was 8.4. At T1 49% of women reported difficulty with recreational activities that involved “some force or impact” and 29% experienced negative changes to their involvement in leisure activities. A hierarchical multiple regression analysis found that several arm morbidity variables were significant predictors of difficulty with participation in recreational activities. A second hierarchical regression found also that arm morbidity factors were significant predictors of negative changes in leisure activities. Follow-up analyses found that arm morbidity, was most closely related to difficulty with recreational activities requiring free movement of the arm and using force. Conclusion Many women treated for breast cancer experience arm morbidity. Arm morbidity is related to difficulties with recreational activities and negative changes in leisure activity participation. Implications Breast cancer survivors should engage in recreational and leisure activities that are compatible with reduced range of motion and pain, and avoid those that exacerbate their arm morbidity.
Introduction Most longitudinal breast cancer studies have found that treatment-related sequelae s... more Introduction Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity [lymphedema, pain, and range of motion (ROM) restrictions] can have a significant impact on quality of life. In a previous study, we found that at 6–12 months after breast cancer surgery, 49% of participants had difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with participation in recreation. Methods A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-surgery. Results Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p Discussion/conclusion Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits. Implications for cancer survivors Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Objective: We proposed to document the effect of arm morbidity and disability in 40 Canadian wome... more Objective: We proposed to document the effect of arm morbidity and disability in 40 Canadian women who were 12-24 months post breast cancer surgery. Methods: We completed 40 qualitative interviews as one component of a multidisciplinary national longitudinal study of arm morbidity after breast cancer (n=745) involving four research sites (Fredericton/Saint John, Montreal, Winnipeg, Surrey). During semi-structured interviews, participants who had reported arm morbidity and disability in earlier surveys were asked to discuss the effects of these conditions on everyday life. Results: The interviewees reported making major adjustments to paid and unpaid work, which often involved the assistance of family members, thus demonstrating the effect of disability. Interview data resulted in the creation of a model that addresses arm morbidity and disability, and that holds implication for health care professionals. Conclusions: Based on the interview findings, we conclude that a robust measure of disability after breast cancer should be developed. In the absence of a validated measure of the effect of disability, evaluating qualitative responses to questions about everyday activities could provide the impetus for provision of physical therapy and emotional support.
Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada, 2004
The purpose of this study was to find out, from the patient's perspective and using qualitati... more The purpose of this study was to find out, from the patient's perspective and using qualitative methodology, how cancer follow-up care is managed in a New Brunswick health region. From focus group discussions with 23 participants 1-year post-cancer diagnosis, 3 prominent themes emerged: fear of recurrence, cancer surveillance/testing and support issues. The fear of recurrence permeates day-to-day life for many patients. To allay these fears, some patients feel a need to be subjected to extensive cancer surveillance. Emotional support, which is important for survivors, is complex. The majority of the participants in this study received cancer follow-up care from specialists. More rural than urban participants received their follow-up care from their family physicians (FPs). Participants had high expectations for follow-up care, regardless of which type of physician--specialist or FP--provided it. If physicians did not provide the level and intensity of care expected by their pati...
INTRODUCTION: Large administrative data set analyses demonstrate that geography has a significant... more INTRODUCTION: Large administrative data set analyses demonstrate that geography has a significant impact on access to health care and subsequent health outcomes. In general, rural populations have poorer access to healthcare services. This article explores the reality of this issue for young adult cancer survivors.METHODS: Data was of a subset of 30 participants from a larger qualitative study that examined cancer survivorship issues for young adult cancer patients in Canada. The subset of participants are from New Brunswick, a predominantly rural province in Eastern Canada with a population of 750,000 spread out over a large geographical area, and from Canada's largest metropolis center, Greater Toronto Area, with a population of around 6 million.RESULTS: Analysis of the qualitative data using constructivist grounded theory revealed several expected and unexpected differences between the two geographically distinct groups. The rural group of young adult cancer survivors reported more frequent episodes of delayed diagnosis and lower levels of community support compared to the urban participants. The urban young adult cancer survivors discussed out-of-pocket expenses for cancer treatment more often than the rural participants. Many rural participants made it clear that they were keenly aware that not all cancer care services were readily available where they lived, and yet they reported considerably higher levels of satisfaction with the cancer care that they received than the urban participants.CONCLUSION: Despite the lack of important cancer services in rural areas, rural young adult cancer survivors expressed higher levels of satisfaction with their care than did urban cancer survivors. It appears that levels of satisfaction are related to expectations. Rural participants were aware of the more limited services available and felt that their cancer care practitioners provided the best care possible given the limited resources. Urban participants may have higher expectations of cancer care and felt that the cancer care they received fell below expectations. In the future, researchers may want to focus on cancer care expectations, satisfaction levels and psychosocial outcomes in greater detail.
To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of... more To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability. Longitudinal mixed methods approach. Four sites across Canada. 347 patients with breast cancer 6-12 months after surgery at first point of data collection. Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed. Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals. Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability. Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.
OBJECTIVE To assess family physicians' and specialists' involvement in cancer follow-up c... more OBJECTIVE To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancer patients. DESIGN Self-administered survey. SETTING A health region in New Brunswick. PARTICIPANTS A nonprobability cluster sample of 183 participants. MAIN OUTCOME MEASURES Patients' perceptions of cancer follow-up care. RESULTS More than a third of participants (36%) were not sure which
The impact of arm morbidity on leisure and quality of life is an understudied area in cancer surv... more The impact of arm morbidity on leisure and quality of life is an understudied area in cancer survivorship. The purpose of this study was to qualitatively describe the impact of breast cancer-related arm morbidity on leisure participation in Canadian women. A grounded theory approach was used to generate thematic categories and a model. Drawing on participants from a larger cohort study (n = 740), 40 women with arm morbidity symptoms were purposively sampled and interviewed. Three themes emerged: a sense of loss, adapting participation, and new directions. Women with arm morbidity may experience an abrupt loss of previously enjoyed leisure activities and engage in a process of adapting to discover new meanings and directions. Comprehensive, person-centred cancer survivorship programs may assist with adaptation to arm morbidity.
Canadian family physician Médecin de famille canadien, 2011
To assess the effects of physician-colleague and coworker abuse on family physicians in Canada. A... more To assess the effects of physician-colleague and coworker abuse on family physicians in Canada. A mixed-methods, bilingual study that included surveys and telephone interviews. Canada. Family physicians in active practice who were members of the College of Family Physicians of Canada in 2009. Surveys were mailed to a random sample of family physicians (N = 3802), and 37 family physicians who had been abused in the past year participated in telephone interviews. A total of 770 surveys (20%) were completed. A small number of respondents reported having been subjected to abuse by physician colleagues (9%) or coworkers (6%) in the previous month. Many of the respondents reported that the same physician colleagues or coworkers were repeat abusers. More than three-quarters (77%) of the physician-colleague abusers were men, whereas more than three-quarters (77%) of the other coworker abusers were women. Interviewed family physicians described feeling humiliated and unappreciated, and devel...
Canadian family physician Médecin de famille canadien, 2006
To examine the experiences with cancer of adults diagnosed when between 20 and 35 years old. Qual... more To examine the experiences with cancer of adults diagnosed when between 20 and 35 years old. Qualitative study using semistructured interviews. Largest health care region in the province of New Brunswick. Six men and 9 women cancer patients and survivors. Fifteen adults interviewed when between the ages of 20 and 43 representing a variety of cancers and stages of disease were recruited for this study. Interviews were guided by a set of open-ended questions and explored participants' experiences with cancer from initial presentation of symptoms through to survivorship issues. The most important clinical issue that emerged from the analysis was that participants' youth appeared to contribute to delays in diagnosis of cancer. These delays were attributed to either patients' or physicians' inaction. Some patients attributed their initial cancer symptoms to the adverse effects of alcohol or excessive partying; others feared a bad diagnosis and delayed seeking help. Family...
To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of... more To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability. Longitudinal mixed methods approach. Four sites across Canada. 347 patients with breast cancer 6-12 months after surgery at first point of data collection. Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed. Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals. Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability. Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.
Introduction: Most longitudinal breast cancer studies have found that treatment-related sequelae ... more Introduction: Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity [lymphedema, pain and range of motion (ROM) restrictions] can have a significant impact on quality of life. In a previous study, we found that 6-12 months after breast cancer surgery, 49% of participants had difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with participation in recreation. Methods: A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-breast cancer surgery. Results: Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p<0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery, with pain accounting for the greatest proportion of variance. Discussion/conclusion: Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits. Implications for cancer survivors: Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Journal of Prevention & Intervention in The Community, 2008
Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treat... more Twenty family physicians (11 female and 9 male) were interviewed about their experiences in treating depressed patients. Interview transcripts were analyzed thematically with respect to physicians' understanding of women's depression and their treatment strategies with depressed women. Stress arising in the social context of women's lives was perceived as a key precipitant of depression in women, with family-related, gender-specific and practical sources of stress as the main contributors. Physicians' treatment strategies had the aims of alleviating depressive symptoms and stress reduction. Implications of the findings for primary health care delivery and community-based interventions with depressed women are discussed.
Introduction A Canadian research team is conducting a multi-centered, non-interventional national... more Introduction A Canadian research team is conducting a multi-centered, non-interventional national study with the objective of charting the course of arm morbidity after breast cancer surgery. This paper examined the relationship between arm morbidity and leisure and recreational activities of affected women. Methods Five hundred and forty seven women with stage I-III breast cancer were recruited in four centers across Canada: Surrey (BC); Winnipeg (MB), Montreal (QB) and Fredericton (NB). Participants were enrolled in the study 6–12 months post surgery. Physical examination was used to assess arm and shoulder functioning and questionnaires were used to assess disability, pain, and participation in recreational and leisure activities. Results At the first clinical assessment (T1), the mean number of months post breast cancer surgery was 8.4. At T1 49% of women reported difficulty with recreational activities that involved “some force or impact” and 29% experienced negative changes to their involvement in leisure activities. A hierarchical multiple regression analysis found that several arm morbidity variables were significant predictors of difficulty with participation in recreational activities. A second hierarchical regression found also that arm morbidity factors were significant predictors of negative changes in leisure activities. Follow-up analyses found that arm morbidity, was most closely related to difficulty with recreational activities requiring free movement of the arm and using force. Conclusion Many women treated for breast cancer experience arm morbidity. Arm morbidity is related to difficulties with recreational activities and negative changes in leisure activity participation. Implications Breast cancer survivors should engage in recreational and leisure activities that are compatible with reduced range of motion and pain, and avoid those that exacerbate their arm morbidity.
Introduction Most longitudinal breast cancer studies have found that treatment-related sequelae s... more Introduction Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity [lymphedema, pain, and range of motion (ROM) restrictions] can have a significant impact on quality of life. In a previous study, we found that at 6–12 months after breast cancer surgery, 49% of participants had difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with participation in recreation. Methods A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-surgery. Results Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p Discussion/conclusion Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits. Implications for cancer survivors Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Objective: We proposed to document the effect of arm morbidity and disability in 40 Canadian wome... more Objective: We proposed to document the effect of arm morbidity and disability in 40 Canadian women who were 12-24 months post breast cancer surgery. Methods: We completed 40 qualitative interviews as one component of a multidisciplinary national longitudinal study of arm morbidity after breast cancer (n=745) involving four research sites (Fredericton/Saint John, Montreal, Winnipeg, Surrey). During semi-structured interviews, participants who had reported arm morbidity and disability in earlier surveys were asked to discuss the effects of these conditions on everyday life. Results: The interviewees reported making major adjustments to paid and unpaid work, which often involved the assistance of family members, thus demonstrating the effect of disability. Interview data resulted in the creation of a model that addresses arm morbidity and disability, and that holds implication for health care professionals. Conclusions: Based on the interview findings, we conclude that a robust measure of disability after breast cancer should be developed. In the absence of a validated measure of the effect of disability, evaluating qualitative responses to questions about everyday activities could provide the impetus for provision of physical therapy and emotional support.
Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada, 2004
The purpose of this study was to find out, from the patient's perspective and using qualitati... more The purpose of this study was to find out, from the patient's perspective and using qualitative methodology, how cancer follow-up care is managed in a New Brunswick health region. From focus group discussions with 23 participants 1-year post-cancer diagnosis, 3 prominent themes emerged: fear of recurrence, cancer surveillance/testing and support issues. The fear of recurrence permeates day-to-day life for many patients. To allay these fears, some patients feel a need to be subjected to extensive cancer surveillance. Emotional support, which is important for survivors, is complex. The majority of the participants in this study received cancer follow-up care from specialists. More rural than urban participants received their follow-up care from their family physicians (FPs). Participants had high expectations for follow-up care, regardless of which type of physician--specialist or FP--provided it. If physicians did not provide the level and intensity of care expected by their pati...
INTRODUCTION: Large administrative data set analyses demonstrate that geography has a significant... more INTRODUCTION: Large administrative data set analyses demonstrate that geography has a significant impact on access to health care and subsequent health outcomes. In general, rural populations have poorer access to healthcare services. This article explores the reality of this issue for young adult cancer survivors.METHODS: Data was of a subset of 30 participants from a larger qualitative study that examined cancer survivorship issues for young adult cancer patients in Canada. The subset of participants are from New Brunswick, a predominantly rural province in Eastern Canada with a population of 750,000 spread out over a large geographical area, and from Canada's largest metropolis center, Greater Toronto Area, with a population of around 6 million.RESULTS: Analysis of the qualitative data using constructivist grounded theory revealed several expected and unexpected differences between the two geographically distinct groups. The rural group of young adult cancer survivors reported more frequent episodes of delayed diagnosis and lower levels of community support compared to the urban participants. The urban young adult cancer survivors discussed out-of-pocket expenses for cancer treatment more often than the rural participants. Many rural participants made it clear that they were keenly aware that not all cancer care services were readily available where they lived, and yet they reported considerably higher levels of satisfaction with the cancer care that they received than the urban participants.CONCLUSION: Despite the lack of important cancer services in rural areas, rural young adult cancer survivors expressed higher levels of satisfaction with their care than did urban cancer survivors. It appears that levels of satisfaction are related to expectations. Rural participants were aware of the more limited services available and felt that their cancer care practitioners provided the best care possible given the limited resources. Urban participants may have higher expectations of cancer care and felt that the cancer care they received fell below expectations. In the future, researchers may want to focus on cancer care expectations, satisfaction levels and psychosocial outcomes in greater detail.
To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of... more To chart the incidence and course of three types of arm morbidity (lymphedema, pain, and range of motion [ROM] restrictions) in women with breast cancer 6-12 months after surgery and the relationship between arm morbidity and disability. Longitudinal mixed methods approach. Four sites across Canada. 347 patients with breast cancer 6-12 months after surgery at first point of data collection. Incidence rates were calculated for three types of arm morbidity, correlations between arm morbidity and disability were computed, and open-ended survey responses were compiled and reviewed. Lymphedema, pain, ROM, and arm, shoulder, and hand disabilities. Almost 12% of participants experienced lymphedema, 39% reported pain, and about 50% had ROM restrictions. Little overlap in the three types of arm morbidity was observed. Pain and ROM restrictions correlated significantly with disability, but most women did not discuss arm morbidity with healthcare professionals. Pain and ROM restrictions are prevalent 6-12 months after surgery, but lymphedema is not. Pain and ROM restrictions are associated with disability. Screening for pain and ROM restrictions should be part of breast cancer follow-up care. Left untreated, arm morbidity could have a long-term effect on quality of life. Additional research into the longevity of various arm morbidity symptoms and possible interrelationships also is required.
OBJECTIVE To assess family physicians' and specialists' involvement in cancer follow-up c... more OBJECTIVE To assess family physicians' and specialists' involvement in cancer follow-up care and how this involvement is perceived by cancer patients. DESIGN Self-administered survey. SETTING A health region in New Brunswick. PARTICIPANTS A nonprobability cluster sample of 183 participants. MAIN OUTCOME MEASURES Patients' perceptions of cancer follow-up care. RESULTS More than a third of participants (36%) were not sure which
The impact of arm morbidity on leisure and quality of life is an understudied area in cancer surv... more The impact of arm morbidity on leisure and quality of life is an understudied area in cancer survivorship. The purpose of this study was to qualitatively describe the impact of breast cancer-related arm morbidity on leisure participation in Canadian women. A grounded theory approach was used to generate thematic categories and a model. Drawing on participants from a larger cohort study (n = 740), 40 women with arm morbidity symptoms were purposively sampled and interviewed. Three themes emerged: a sense of loss, adapting participation, and new directions. Women with arm morbidity may experience an abrupt loss of previously enjoyed leisure activities and engage in a process of adapting to discover new meanings and directions. Comprehensive, person-centred cancer survivorship programs may assist with adaptation to arm morbidity.
Canadian family physician Médecin de famille canadien, 2011
To assess the effects of physician-colleague and coworker abuse on family physicians in Canada. A... more To assess the effects of physician-colleague and coworker abuse on family physicians in Canada. A mixed-methods, bilingual study that included surveys and telephone interviews. Canada. Family physicians in active practice who were members of the College of Family Physicians of Canada in 2009. Surveys were mailed to a random sample of family physicians (N = 3802), and 37 family physicians who had been abused in the past year participated in telephone interviews. A total of 770 surveys (20%) were completed. A small number of respondents reported having been subjected to abuse by physician colleagues (9%) or coworkers (6%) in the previous month. Many of the respondents reported that the same physician colleagues or coworkers were repeat abusers. More than three-quarters (77%) of the physician-colleague abusers were men, whereas more than three-quarters (77%) of the other coworker abusers were women. Interviewed family physicians described feeling humiliated and unappreciated, and devel...
Canadian family physician Médecin de famille canadien, 2006
To examine the experiences with cancer of adults diagnosed when between 20 and 35 years old. Qual... more To examine the experiences with cancer of adults diagnosed when between 20 and 35 years old. Qualitative study using semistructured interviews. Largest health care region in the province of New Brunswick. Six men and 9 women cancer patients and survivors. Fifteen adults interviewed when between the ages of 20 and 43 representing a variety of cancers and stages of disease were recruited for this study. Interviews were guided by a set of open-ended questions and explored participants' experiences with cancer from initial presentation of symptoms through to survivorship issues. The most important clinical issue that emerged from the analysis was that participants' youth appeared to contribute to delays in diagnosis of cancer. These delays were attributed to either patients' or physicians' inaction. Some patients attributed their initial cancer symptoms to the adverse effects of alcohol or excessive partying; others feared a bad diagnosis and delayed seeking help. Family...
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Papers by Baukje Miedema
Methods: A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-breast cancer surgery.
Results: Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p<0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery, with pain accounting for the greatest proportion of variance.
Discussion/conclusion: Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits.
Implications for cancer survivors: Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Methods: We completed 40 qualitative interviews as one component of a multidisciplinary national longitudinal study of arm morbidity after breast cancer (n=745) involving four research sites (Fredericton/Saint John, Montreal, Winnipeg, Surrey). During semi-structured interviews, participants who had reported arm morbidity and disability in earlier surveys were asked to discuss the effects of these conditions on everyday life.
Results: The interviewees reported making major adjustments to paid and unpaid work, which often involved the assistance of family members, thus demonstrating the effect of disability. Interview data resulted in the creation of a model that addresses arm morbidity and disability, and that holds implication for health care professionals.
Conclusions: Based on the interview findings, we conclude that a robust measure of disability after breast cancer should be developed. In the absence of a validated measure of the effect of disability, evaluating qualitative responses to questions about everyday activities could provide the impetus for provision of physical therapy and emotional support.
Methods: A longitudinal national study employing clinical assessments and survey methods followed 178 women over 43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical multiple regression analyses were conducted to identify which variables were predictive of recreational difficulties experienced by women 8 and 43 months post-breast cancer surgery.
Results: Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be statistically significant (p<0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery, with pain accounting for the greatest proportion of variance.
Discussion/conclusion: Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6 years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer surgery report difficulties in their recreational pursuits.
Implications for cancer survivors: Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should be sought.
Methods: We completed 40 qualitative interviews as one component of a multidisciplinary national longitudinal study of arm morbidity after breast cancer (n=745) involving four research sites (Fredericton/Saint John, Montreal, Winnipeg, Surrey). During semi-structured interviews, participants who had reported arm morbidity and disability in earlier surveys were asked to discuss the effects of these conditions on everyday life.
Results: The interviewees reported making major adjustments to paid and unpaid work, which often involved the assistance of family members, thus demonstrating the effect of disability. Interview data resulted in the creation of a model that addresses arm morbidity and disability, and that holds implication for health care professionals.
Conclusions: Based on the interview findings, we conclude that a robust measure of disability after breast cancer should be developed. In the absence of a validated measure of the effect of disability, evaluating qualitative responses to questions about everyday activities could provide the impetus for provision of physical therapy and emotional support.