An Evolving Model for Understanding the Impact of Disability After Breast Cancer

Increased screening and more effective treatments have led to improved survival rates for breast cancer; however, treatment often results in arm morbidity (i.e., pain, lymphedema and range of motion restrictions). Arm morbidity can have a significant impact on quality of life. Our interdisciplinary team's mixed methods project involves following women (n = 745) across Canada for a 5 year period in order to document the trajectory of arm morbidity (disability) and its impact on various aspects of the women's lives. Of the women enrolled in the study, a sub-sample of 40 women completed in-depth interviews, 12-24 months post-surgery. The analysis of the initial interviews resulted in a publication (2009) which included a visual model, addressing themes such as impact on paid work, leisure, and family. Since that time, follow-up interviews with the sub-sample have been completed. The objective of this poster presentation is to document the evolution of the model of disability over time. Adaptations to the model include recognition of temporal factors associated with disability, along with the conceptualization of loss, and the potential for rehabilitation. Longitudinal, qualitative data provide documentation of the impact of disability on the lives of breast cancer survivors. This data suggest that for some women, there is deterioration and loss, but also opportunities to recognize their resilience. Subsequent analyses which triangulate the study's quantitative and qualitative findings represent the next phase of this program of research, and will provide a more holistic picture of experiences of arm morbidity. In the meantime, supportive care for breast cancer survivors should recognize the complexity of interrelated social and psychological factors related to disability, as described by those directly affected. This research is supported by an operating grant from the Canadian Institutes of Health Research (CIHR).