A systematic review of m-health apps on managing side effects of breast cancer treatment.

PURPOSE: After breast cancer treatment, women with breast cancer may experience distress caused by treatment side effects, both in physical and psychological aspects. Technology use is increasing in favor among women. Therefore, it is essential to update the scientific evidence regarding mobile and web apps' effectiveness in managing the side effects of breast cancer treatments for breast cancer survivors. The purpose of this systematic review was to investigate the scientific evidence on the effectiveness of mobile and web apps in managing the side effects of breast cancer treatments among this group. METHODS: A literature search was conducted using ScienceDirect, Scopus, PubMed, CINAHL, and Cochrane. Published papers in English focused on mobile and web apps and the side effects of breast cancer treatment in breast cancer survivors were selected. The search reviewed studies from January 2011 to December 2021. From a total of 925 retrieved manuscripts, 11 studies were included for analysis. RESULTS: The findings showed that mobile apps were more frequently used and more likely to be an effective method for managing the side effects of breast cancer treatment among breast cancer survivors. The content in web or mobile apps for breast cancer survivors should include five categories: (1) information about cancer, (2) overview of cancer care, (3) opportunities for interaction with other people, (4) symptom management strategies, and (5) feedback about cancer treatment side effect management. However, a few studies examined the effects of a combination of mobile and web apps in managing breast cancer treatment side effects. Therefore, future research is needed to examine solo and combination use. In addition, more rigorous studies are warranted to examine these interventions. CONCLUSIONS: Nurses may refer survivors to these resources to obtain more information and effectively manage the signs and symptoms of breast cancer and its treatment side effects.

Improving mental health literacy in adolescents: systematic review of supporting intervention studies.

OBJECTIVE: Mental health literacy (MHL) in adolescents is an important issue as it can lead to early detection and recognition of mental illness. The aim of this systematic review was to explore the effect of supporting interventions on improving MHL in adolescents. METHODS: Systematic literature review by searching the ScienceDirect, Scopus, PubMed, Crochrane and CINAHL databases. Seven of 1107 papers were included in the final review. RESULTS: Supporting interventions for improving MHL in adolescents could be categorised into school-based and community-based. Both types used an education stand-alone strategy or an education plus contact-based group in their programmes. To provide knowledge of mental illness to adolescents, teaching methods should be interactive and use various media such as group discussion, videos and movies. CONCLUSIONS: School-based and community-based interventions were likely to improve MHL among adolescents. However, further research with objective tool measures is needed to confirm the findings.

OBJECTIF: La littératie sur la santé mentale (LSM) chez les adolescents est un sujet important car elle peut conduire à la détection et à la reconnaissance précoces des maladies mentales. Le but de cette revue systématique était d'explorer l'effet du soutien des interventions sur l'amélioration de la LSM chez les adolescents. MÉTHODES: Analyse systématique de la littérature en recherchant dans les bases de données ScienceDirect, Scopus, PubMed, Crochrane et CINAHL. 7 des 1.107 articles ont été inclus dans l'analyse finale. RÉSULTATS: L'effet des interventions de soutien visant à améliorer la LSM chez les adolescents pourraient être classés en soit du milieu scolaire, soit communautaire. Les deux types ont utilisé une stratégie basée sur l'éducation seule ou sur l'éducation et des contacts dans leurs programmes. Fournir des connaissances de la maladie mentale aux adolescents, les méthodes d'enseignement devraient être interactifs et utiliser divers médias comme la discussion de groupe, des vidéos et des films. CONCLUSIONS: Les interventions en milieu scolaire et communautaires étaient susceptibles d'améliorer la LSM chez les adolescents. Cependant, des recherches supplémentaires avec des mesures d'outils objectives sont nécessaires pour confirmer les résultats.

Breast cancer survivorship in rural settings: a systematic review.

PURPOSE: Rural breast cancer survivors (BCS) in the United States face unique challenges during survivorship, related to knowledge and accessibility of resources. Survivorship care plans should address five key areas that include surveillance and screening for new/reoccurring cancer; management of long-term effects of cancer treatment; health promotion; and care coordination/practice implications. To maximize the benefit of survivorship care for rural BCS, it is necessary to better understand their experiences and preferences. METHODS: A systematic review of the extant literature addressing the survivorship needs and interventions for rural BCS was conducted. The following databases were searched for reports published between January, 2007, and December, 2018: PubMed, CINAHL, SCOPUS, PsycINFO (EBSCO), CAB Direct, and Sociological Abstracts. Reports published after 2007 with samples including and comprised of rural BCS in the United States were included. Screening of the search results followed PRISMA guidelines using Covidence systematic review software. RESULTS: Findings were extracted from 30 reports disseminating findings of 14 research studies. The five areas of a survivorship care were counted/accounted for during data extraction. The included reports concentrated on health promotion (e.g., weight loss and exercise) and the management of long-term effects of cancer treatment as key outcomes. There is a gap in the literature addressing care coordination, surveillance, and screening. CONCLUSION: Additional research including interventions for rural BCS that address more survivorship care areas would benefit this population and improve survivorship quality of life for rural BCS.

Thai nurses' perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand.

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well-being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno-nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.

Self-management of lymphedema: a systematic review of the literature from 2004 to 2011.

BACKGROUND: Little is known about the effectiveness of activities used to self-manage lymphedema. OBJECTIVE: The aim of this study was to evaluate the level of evidence of peer-reviewed lymphedema self-care literature published from January 2004 to May 2011. METHODS: Eleven major medical databases were searched. Articles were selected for inclusion or exclusion into the category of self-management of lymphedema by topic experts. The definition of self-management included activities that individuals initiate and perform for themselves without the assistance of others. Articles were scored according to the Oncology Nursing Society's Putting Evidence Into Practice levels of evidence. RESULTS: Sixteen articles met criteria for inclusion in this review, with self-management as the independent variable. Ten categories of self-management were established subsequently and articles were classified by levels of evidence. In these categories, no self-management studies were rated as "recommended for practice," 2 studies were rated "likely to be effective," none was rated "benefits balanced with harms," 7 were rated "effectiveness not established," and 1 was rated "effectiveness unlikely." DISCUSSION: Few studies included measures of outcomes associated with lymphedema, and there was a scarcity of randomized controlled trials in lymphedema self-management. A demonstrated need exists for the design and testing of self-management interventions that include appropriate outcome measures.

Performance care practices in complementary and alternative medicine by Thai breast cancer survivors: an ethnonursing study.

The purpose of this study was to explore how Thai breast cancer survivors perform care practices in complementary and alternative medicine to promote their health and well-being. Research was conducted using an ethnonursing method. Data were collected through semi-structured interviews with 17 Thai breast cancer survivors in Thailand. The transcribed interviews were analyzed using the ethnonursing analysis method. The findings showed Thai breast cancer survivors started their care practices in complementary and alternative medicine immediately following a diagnosis of breast cancer. They sought out and gathered alternative medicine information from several sources, such as the people around them, media resources, books, magazines, or newspapers. After gathering information, Thai breast cancer survivors would try out various types of complementary medicines rather than use only one type because of information from other people and their own evaluation. The findings of this study indicate the need for a conversation about complementary medicine use between healthcare providers and Thai breast cancer survivors as an on-going process throughout the cancer trajectory to ensure that safe and holistic care is provided.

A needs assessment for competency development of nurse educators.

OBJECTIVE: The purposes of this study were to assess the current competencies and desired competency development of nurse educators and to examine differences in how they ranked their needs by participants' gender, age, educational qualification, and work experience. METHODS: We conducted a cross-sectional study. Participants were 435 nurse educators working at nursing colleges under the Ministry of Public Health, Thailand, in 2021. RESULTS: Participants had significantly higher desired scores for competency development than the actual condition scores (p < .05). They prioritized their competence development needs from highest to lowest scores as follows: (1) nursing knowledge, (2) teaching pedagogy, (3) learning activities preparation, (4) professional value, (5) learning atmosphere building, (6) educator professional ethics, (7) learning outcomes measures, and (8) learning plan. Participants with different gender, education levels, ages, and work experiences set similar priorities for competency development needs. CONCLUSION: Nurse educators first emphasized knowledge and teaching skills improvement, followed by enhancing value. However, their needs were not different when categorized by gender, age, educational qualification, and work experience. Therefore, planning to develop all competencies is urged and prioritized. Similarly, future research should explore suitable competency development programs for these nurse educators in each area. Our study's findings could be an example applied to other nursing schools worldwide to improve nurse educators' competencies.

Characteristics of effective nurse educators from Thai nursing students' perspectives.

Background: Effective nurse educators will improve students' performance. Therefore, examining the characteristics of an effective nurse educator is essential, especially from nursing students' perspectives, which will provide an additional point of view to improve the teachers' quality. Objectives: This research aimed to identify nursing students' opinions regarding the characteristics of effective nurse educators and to compare those characteristics according to age, year of study, and cumulative grade point average. Methods: A descriptive quantitative design was used. Data were collected from 400 nursing students in Thailand using a validated questionnaire. Descriptive statistics, t-tests, and F-tests were used for data analysis. Results: The overall mean scores of effective nurse educators' characteristics based on students' perspectives were 4.36 (SD = 0.45). Subject expertise was the most essential characteristic of the effective nurse educators (Mean = 4.45, SD = 0.47), followed by relational expertise (Mean = 4.44, SD = 0.52), personality (Mean = 4.36, SD = 0.45), and teaching-related behavior (Mean = 4.33, SD = 0.46). The results also showed that participants with different cumulative grade point averages had no different views on the characteristics of effective nurse educators (p > 0.05). However, participants of different ages and years of study had significantly different perspectives on the characteristics of effective nurse educators (p < 0.05). Conclusion: The study offers necessary information regarding the essential characteristics of effective nurse educators. Therefore, nurse educators can use the study results to improve their desired characteristics. In addition, faculty development programs may be planned to help nurse educators improve these characteristics.

Manual Lymphedema Drainage for Reducing Risk for and Managing Breast Cancer-Related Lymphedema After Breast Surgery: A Systematic Review.

OBJECTIVE: To examine the effects of manual lymphatic drainage (MLD) on reducing the risk of and managing breast cancer-related lymphedema (BCRL). DATA SOURCES: The electronic databases ScienceDirect, Scopus, PubMed, and CINAHL were searched for articles published in the English language from January 2000 to June 2020. STUDY SELECTION: A total of 518 articles were retrieved. After the removal of duplicates, 472 articles remained, 433 of which were excluded based on title and abstract consideration. Thereafter, 39 studies were further inspected, and 27 articles were excluded because they were not randomized controlled trials, did not measure BCRL, and/or were an incomplete study. Ten studies were included for the final review. DATA EXTRACTION: Data from the 10 studies were extracted and compiled into a summary table. DATA SYNTHESIS: Based on the results of this systematic review, it cannot be concluded that MLD helps reduce the risk of BCRL for women after breast surgery. Regarding the effect of MLD on managing BCRL, the findings indicate that MLD alone or MLD combined with other treatments was likely to give similar benefits in terms of reducing arm volume for women diagnosed with BCRL. CONCLUSION: Scientific evidence to support the benefits of MLD on preventing or reducing BCRL remains unclear. More rigorous studies to confirm findings on the effectiveness of MLD are needed.

Breast cancer-related lymphedema and quality of life: A qualitative analysis over years of survivorship.

OBJECTIVES: The study purpose was to examine perspectives of women with newly diagnosed breast cancer-related lymphedema (BCRL) regarding their quality of life over seven years. METHOD: Data were collected over seven years using the Lymphedema and Breast Cancer Questionnaire (LBCQ). Participants with BCRL answered open-ended questions corresponding to changes in mood and lifestyle from post-op through annual interviews and surveys. Self-reported data from 97 participants with BCRL were analyzed using in vivo coding and template-style content analysis to elicit the impact of BCRL on quality of life domains. RESULTS: Data saturation was achieved as participants neared 30 to 36 months post- breast cancer diagnosis. Three major themes were identified related to BCRL's impact on: physical function; daily living and social function; and psychological function. DISCUSSION: Findings suggest that BCRL impacts quality of life not only soon after diagnosis, but also throughout survivorship years. Healthcare providers should develop programs to enhance quality of life for survivors with BCRL.

A systematic review association of reflexology in managing symptoms and side effects of breast cancer treatment.

BACKGROUND: Reflexology is one of complementary approaches most used by patients with breast cancer. The purpose of this article was to evaluate the effects of reflexology on managing symptoms and side effects of breast cancer treatment. METHODS: Data sources included PubMed, CINAHL, ScienceDirect, and Scopus. The criteria were applied to 224 articles and only six articles met the criteria. RESULTS: Four studies were randomized control trials and two were quasi-experimental designs. Sample sizes varied from 60 to 385 participants. All reflexology programs were taught by certified reflexologists. The results showed that reflexology is associated with benefits for both psychological and physical aspects. Reflexology was reported to improve quality of life, but not for depression or anxiety. It was also beneficial for reducing fatigue, nausea, and vomiting, but not for peripheral neuropathy. CONCLUSIONS: enough high-level evidence has not been reported to confirm the effectiveness of reflexology on breast cancer symptom management.

Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema: A systematic review.

The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema. Published articles written in English were retrieved from electronic databases, including ScienceDirect, PubMed, Scopus, and CINAHL databases. Hand-searches for unpublished papers were also completed. Content analysis was used to examine articles that met the inclusion criteria. Among 525 searched papers, 15 papers met the inclusion criteria: 13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise. The results of the review showed that no arm volume change was observed for either exercise modality. In addition, six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema. For patients with breast cancer-related lymphedema, six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group. However, three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group. The findings suggest that supervised resistance exercise may be safe, feasible, and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema. However, the limitation of small sample size implies that further research is needed to confirm these findings.

Complementary Health Approaches: Overcoming Barriers to Open Communication During Cancer Therapy
.

BACKGROUND: Complementary health approaches (CHAs) have been widely used by patients with cancer for many reasons. However, some patients choose not to disclose their use of CHAs to their nurses, fearing that this use will be viewed as unacceptable. Nurses may be uncomfortable talking about CHAs because of a lack of evidence-based research on the subject.
. OBJECTIVES: This article promotes ways in which nurses can overcome barriers to open communication about CHAs with patients during cancer therapy.
. METHODS: The literature related to CHAs and communication was reviewed.
. FINDINGS: To encourage open communication between nurses and patients regarding the use of CHAs, nurses need to be more knowledgeable about CHAs through training or by conducting research related to CHAs.

Use of complementary and alternative medicine among Thai patients with type 2 diabetes mellitus.

OBJECTIVE: Patients with diabetes commonly use complementary and alternative medicine (CAM). Little is known about types and factors related to CAM use in patients with diabetes in Thailand. This study aimed to examine types and factors that were associated with CAM use in Thai diabetic patients. METHODS: A cross-sectional study of diabetic patients being treated in four primary healthcare units and two secondary hospitals in the north of Thailand was conducted. A questionnaire was used to collect data. Frequency, percentage, and Chi-square test were used to describe or analyze data. RESULTS: The three most common types of CAM used by samples were Daode Xinxi (a modified version of Taichi), prayer and meditation. Women were more likely to use CAM than men (χ(2)=5.038, P=0.018). Patients aged between 40 and 69 years were more likely to use CAM than those aged younger than 40 or older than 69 years (χ(2)=11.041, P=0.026). Farmers were more likely to use CAM than those with other careers (χ(2)=19.248, P=0.007). Diabetes patients whose time since diagnosis was between 1 and 10 years were more likely to use CAM than those with a longer elapsed time since diagnosis (χ(2) = 8.407, P = 0.038). Marital status, religion, education, health insurance type and conventional treatment approaches were not associated with CAM use in diabetic patients. CONCLUSION: The most common type of CAM used by Thai patients with diabetes was mind and body practice. CAM use was significantly associated with gender, age, career and duration of diabetes. However, marital status, religion, education, health insurance types and conventional regimen for diabetics were not associated with CAM use.

Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment.

This study explored breast cancer survivors' perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants' comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.

Exploring the usefulness of botanicals as an adjunctive treatment for lymphedema: a systematic search and review.

OBJECTIVES: To provide a critical analysis of the current published research regarding the use, risks, and benefits of botanicals in the treatment of lymphedema and to provide health professionals with current knowledge of safe, appropriate use of botanicals for treatment of lymphedema. TYPE: This systematic search and review addresses the use of botanicals in the treatment of lymphedema in order to develop a best evidence synthesis of the research. LITERATURE SURVEY: Articles were identified from 11 major medical indices published from 2004-2012 using search terms for lymphedema and management. Eighty-five articles met the inclusion criteria of evidence-based lymphedema therapies for the category "complementary and alternative methods for lymphedema therapy." METHODOLOGY: Two clinical lymphedema experts reviewed the studies according to level of evidence guidelines established by the Oncology Nursing Society, Putting Evidence into Practice, and subdivided the methods into subcategories that included Botanical, Pharmaceutical, Physical Agent Modalities, and Modalities of Contemporary Value. The pharmaceutical articles were excluded (5) because they fell outside the inclusion criteria. Twenty-two articles were used in a separate review of physical agent modalities and modalities of contemporary value for lymphedema. Botanicals generated substantial research (11) and warranted its own independent review. SYNTHESIS: The levels of evidence are weak, because research conclusions were limited by size, dose, and study design. A limited number of randomized controlled trials have been performed, and reliability is not always evident, particularly in the context of large systematic reviews where evidence was bundled. CONCLUSIONS: Evidence supporting the use of botanicals for the treatment of lymphedema is insufficient. Some evidence suggests benefits for the treatment of chronic venous insufficiency. Development of specific and sensitive measurement methods may change how botanicals are studied and establish a body of evidence for their use.

Complementary, alternative, and other noncomplete decongestive therapy treatment methods in the management of lymphedema: a systematic search and review.

OBJECTIVES: (1) To provide a critical analysis of the contemporary published research that pertains to complementary, alternative, and other noncomplete decongestive therapies for treatment of lymphedema (LE), and (2) to provide practical applications of that evidence to improve care of patients with or at risk for LE. TYPE: This study meets the defining criteria as a systematic search and review because it includes varied study types. All studies that met the inclusion criteria were evaluated for weight of evidence and value. LITERATURE SURVEY: The systematic search and review includes articles published in the contemporary literature (2004-2012). Publications published from 2004-2011 were retrieved from 11 major medical indices by using search terms for LE and management approaches. Literature archives were examined through 2012. Data extraction included study design, objectives pertaining to LE, number and characteristics of participants, interventions, and outcomes. Study strengths and weaknesses were summarized. Study evidence was categorized according to the Oncology Nursing Society Putting Evidence into Practice level-of-evidence guidelines after achieving consensus among the authors. No authors participated in development of nor benefitted from the review of these modality methods or devices. METHODOLOGY: Extracted data from 85 studies were reviewed in 4 subcategories: botanical, pharmaceutical, physical agent modality, and modalities of contemporary value. After review, 47 articles were excluded, which left 16 articles on botanicals and pharmaceuticals and 22 articles for physical agent modality and/or modalities of contemporary value. Pharmaceuticals were later excluded. The authors concluded that botanicals had generated sufficient studies to support a second, more specific systematic review; thus, botanicals are reported elsewhere. SYNTHESIS: It was found that limited high-level evidence was available for all categories. Well-constructed randomized controlled trials related specifically to LE were limited. Objective outcome measures over time were absent from several studies. The rationale for the use and benefits of the specific modality, as related to LE, was often anecdotal. Subject numbers were fewer than 50 for most studies. CONCLUSIONS: No interventions were ranked as "recommended for practice" based on the Putting Evidence into Practice guidelines. Two treatment modalities in 3 studies were ranked as "likely to be effective" in reducing LE or in managing secondary LE complications. Consideration should be given that many of the PAMs demonstrate long-standing support within the literature, with broad parameters for therapeutic application and benefit for secondary conditions associated with LE. However, further investigation as to their individual contributory value and the factors that contribute to their efficacy, specific to LE, has not been done. It also is significant to mention that the majority of these studies focused on breast cancer-related LE. Studies that explored treatment interventions for LE-related vascular disorders (eg, chronic venous insufficiency, congenital dysphasia, trauma) were sparse. Limitations of the literature support the recommendations for future research to further examine the level of evidence in these modalities for LE management.

Complementary and alternative medicine and lymphedema.

OBJECTIVES: To review the evidence for the effectiveness of complementary and alternative medicine (CAM) on cancer-related lymphedema. DATA SOURCES: CINAHL, PsycINFO, and PubMed (1990-2012). CONCLUSION: To date, there is insufficient evidence to draw conclusions about the benefits of CAM use for cancer patients with lymphedema. Although some CAM types may offer positive effects for the management of lymphedema, negative adverse effects have also been observed. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses and therapists should be aware of and ready to educate cancer patients about the potential effects of CAM. A conversation about the potential risks and benefits of CAM use should be provided.

Management of lymphedema for cancer patients with complex needs.

OBJECTIVES: The purpose of this paper was to discuss the management of lymphedema in patients with advanced disease. DATA SOURCES: Peer-reviewed literature. CONCLUSION: Management of lymphedema in patients with advanced cancer is complex because of multi-factorial issues. Basic components of skin care, compression, massage, and exercise can be applied for these patients. Key concepts are: 1) optimizing quality of life, 2) respecting patients' choices, and 3) providing psychological support to the patients and their families. IMPLICATIONS FOR NURSING PRACTICE: Management plans for patients with lymphedema in advanced disease should be flexible. Holistic and collaborative approaches are essential to achieve the goal of caring for these patients.

Upper extremity lymphedema: presence and effect on functioning five years after breast cancer treatment.

PURPOSE/OBJECTIVE: Our goal was to explore the effects of lymphedema on long-term adjustment among breast cancer survivors, in terms of functioning in important life environments. RESEARCH METHOD/DESIGN: Limb volume measurements and psychosocial survey data were collected from women shortly after undergoing surgical intervention for breast cancer and annually thereafter. A subset of these women were selected for the current study because they had preoperative limb volume measurement data, which is best suited to determine presence and severity of lymphedema. Our final sample of 61 women had both the arm measurements (preoperative and 5-year) and survey data (baseline and 5-year) needed for this study, which comprises a secondary cross-sectional analysis of longitudinal data. A correlational approach was used to explore associations among lymphedema (presence, severity, and whether the participant met the criteria for lymphedema at any assessment point since their treatment for breast cancer) and outcome variables (physical functioning, vocational functioning, social functioning, domestic functioning, and sexual functioning). RESULTS: Each of the three measures of lymphedema was significantly correlated with domestic functioning, but not with functioning in other common environments. CONCLUSIONS/IMPLICATIONS: Long-term breast cancer survivors are at risk for developing secondary conditions, such as lymphedema, to which they must learn to adjust and adapt. Lymphedema may increase risk for compromised functioning in everyday environments, a problem which lies at the heart of rehabilitation. Breast cancer survivorship, therefore, fits well within the scope of a rehabilitation framework.