The perceived role of cancer specialists in breast cancer-related arm morbidity care

With the exception of nonmelanoma skin cancer, breast cancer continues to be the most common cancer diagnosis in women and, due to early detection and better treatment therapies, more women are living longer after breast cancer treatment (Ugnat et al, 2005; Vivar and McQueen, 2005; Grunfeld et al, 2006). In light of these changes, it is anticipated that 10 million breast cancer survivors worldwide will be at risk of developing one or more forms of treatmentrelated arm morbidity (Ferlay et al, 2002; American Cancer Society, 2007; Armer and Stewart, 2011), a condition that can result in physical limitations and disability (Badger, 1988; Thomas-MacLean et al, 2009). Despite this forecast, it remains unclear which clinicians are, or should be, responsible for providing care to survivors living with treatment-related arm morbidity (i.e. pain, range-of-motion restrictions, and/ or lymphoedema). To address this gap in breast cancer follow-up care, the authors interviewed breast cancer specialists in Canada regarding what role, if any, they (Disa and Petrek, 2001; Armer and Stewart, 2011; Radina and Fu, 2012), and has been described as one of the most significant issues facing survivors at present (Cormier et al, 2010). The research shows that clinicians may be dismissive and may disregard symptoms, complicating the context of secondary lymphoedema diagnosis and treatment (Collins et al, 2004; Greenslade and House, 2006; Lee et al, 2010). Lee et al (2010) attribute such attitudes and actions to lack of management knowledge, unavailability of appropriate referrals and perception of symptoms as mild (Lee et al, 2010). The results of a consensus meeting of 108 Canadian lymphoedema stakeholders support these assertions (Hodgson et al, 2011). It has recently been argued that the implementation of less-invasive surgical techniques, such as sentinel lymph node biopsy (SLNB) and more targeted and refined radiation methods, have significantly reduced the incidence of breast cancer-related lymphoedema (McLaughlin Abstract