Consistency of breast and arm symptoms during the first two years after breast cancer surgery.

PURPOSE/OBJECTIVES: To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms. DESIGN: Prospective cohort study with two-year follow-up. SETTING: Three institutions in the Stockholm, Sweden, region. SAMPLE: 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer. METHODS: Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis. MAIN RESEARCH VARIABLES: Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire. FINDINGS: Most participants had undergone breast-conserving surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years. CONCLUSIONS: Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms. IMPLICATIONS FOR NURSING: For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.

[A micro-education programme for breastfeeding women: a pilot study to investigate the educations' effect on injured and painful nipples]. / Mikroschulungsprogramm für stillende Wöchnerinnen: Pilotstudie zur Auswirkung der Schulungen auf schmerzende und wunde Mamillen.

Injured and painful nipples are frequently occurring events in nursing women during the first days after giving birth. These problems often result in a premature termination of breastfeeding despite the mother's wish to nurse. Unsystematic instructions given to women regarding correct breastfeeding increase the risk that these complications will arise. The objective of the study was to investigate the effect of a systematic micro-education programme for nursing women by means of a pilot study or a quasi-experiment. The study included 100 mother and child pairs each in the experimental group and in the control group (N = 200). The pain experienced by all women during nursing was measured using the Visual Analogue Scale (VAS) and the degree of injury to the nipples after nursing was measured with a tool specially developed for this purpose, the Nipple Wound Score (NWS). Women who received instructions by means of the micro-education programme exhibited significantly less injured nipples (on the third day: experimental group 55 % and control group 77 %, p < 0.00; on the fourth day: 56 % and 80 %, p < 0.00).No differences were observed between the study groups in regard to the occurrence of pain (on the fourth day p = 0.68). The variables of birthing method, parity, age or nationality of the women had no effect on the degree of injury of the nipples or on the intensity of pain. The results of this pilot study suggest that repeated micro-education for breastfeeding women should be implemented during the first days after giving birth.