Research Profile – Restricted Movement

A University of Ottawa researcher studies loss of arm function in breast cancer patients.

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For the first time in Canada, researchers are investigating the frequency of arm problems in women who have undergone breast cancer treatment, and they have found that over half of this population experience pain, ongoing swelling and restricted motion.

"Health care professionals and patients alike don't receive a lot of information about pain, range of motion restrictions or lymphedema," says Dr. Roanne Thomas, Canada Research Chair, School of Rehabilitation at the University of Ottawa. Yet they are the three key causes of the arm pain.

But more than that, very little is known about arm problems in women post-breast cancer surgery, she says. To address the issue, she and her research team launched a study which includes 745 women from four sites across Canada: Fredericton, Saint John, Montreal and Surrey. The women entered the study several months after they had surgery for breast cancer.

The study is ongoing, and findings are preliminary, but so far, 30–40% of study participants report arm problems – a much higher number than researchers anticipated. And the problems are interfering with daily activities such as driving, lifting, opening jars, and even holding a leash when walking a dog. One patient worked as a trapper for a living, but reported that the arm problems were so bad she can no longer work the traps, Dr. Thomas says.

"A very high proportion of women in the study weren't receiving treatment for their symptoms," she says. Many women entered the study with arm problems, and some developed arm problems several months later. The women have an average age of about 50, and many are still in the work force.

For the study, the women's symptoms are clinically assessed once a year for five years. Participants are also interviewed by phone between assessments.

So far, about 12% of the women were found to have lymphedema. This is a condition in which there is pooling of lymphatic fluid, and swelling, caused by trauma to the lymph nodes. In some cases, swelling can be quite severe. In breast cancer, lymph nodes located near the armpit are sometimes removed or irradiated as part of the cancer treatment. Women who undergo more extensive lymph node removal are more likely to experience lymphedema.

Since the study started, some spin-off projects have begun – such as a study investigating whether yoga exercises can help restore some arm movement in subgroups of the patients. As well, there is increasing awareness of lymphedema in this patient population.

"Patient advocacy efforts have really taken off since we started the study ... there is now a national group, the Canadian Lymphedema Framework, which is about to launch a magazine for patients and health care professionals. We're excited to be contributing to this movement," says Dr. Thomas.

She hopes the research will lead to not only greater awareness of the various arm problems these women experience, but also greater efforts into finding the best ways to treat the problems and help women restore arm function.

"Health care professionals and patients alike don't receive a lot of information about pain, range of motion restrictions or lymphedema."

– Dr. Roanne Thomas, University of Ottawa