Occupational engagement of women with post-breast cancer lymphoedema : using women's perspectives to create an evidence-base

Introduction: There is a critical need to develop an evidencebase to guide occupational therapy services for women with post breast cancer lymphoedema. Importantly, this evidence must address the impact of lymphoedema on occupational engagement of women. In addition, it is critical to identify the strategies women use to accommodate this life-long condition in everyday life. To date, current evidence focuses on psychological adaptation or treatment techniques to reduce swelling. Very little research has taken an occupational perspective to identify how lymphoedema changes women's participation in valued occupations. Objectives: This qualitative study aimed to identify and explore how post-breast cancer lymphoedema affects women's occupations and the adaptations used to accommodate for these changes to resume a meaningful life. Methods: Semi-structured in-depth interviews were completed with 15 women undergoing treatment at a Sydney lymphoedema clinic (mean age 59 years). Interviews examined the occupational impact of lymphoedema. Qualitative analysis, using grounded theory methods, revealed conceptual categories pertaining to women's experience of living with lymphoedema. Results: Results provide one of the first detailed accounts of how post-breast cancer lymphoedema affects women's engagement in meaningful occupations. Women adopted unique strategies to accommodate their condition, including modifying occupations and environments, and participating in new occupations to replace those lost. Women revealed a constant awareness of their affected arm and the need to protect it during daily occupations. Conclusion: This new evidence is critical to shaping future practice. To address women's occupational needs, therapy programs must adopt an occupation-based approach to treatment to improve women's participation.