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Older women who are depressed following breast cancer therapy are less likely to fully recover shoulder mobility

After breast cancer therapy, women often suffer from limited range of shoulder motion, as well as shoulder pain, weakness, and/or swelling. These problems can interfere with their ability to engage in activities such as cooking, housework, and grocery shopping. Older women newly diagnosed with breast cancer who have depressive symptoms 2 months after diagnosis are less likely to recovery shoulder mobility a year later, concludes a new study. Women with depression are probably less likely to adhere to treatment to improve range of motion, notes Jean L. Freeman, Ph.D., of the University of Texas Medical Branch, Galveston.

Dr. Freeman and coinvestigators examined depressive symptoms 2 months after diagnosis of breast cancer among 187 women aged 60 years and older involved in a nurse case management trial from 1993 to 1996. They also examined their sociodemographic characteristics, type of breast cancer treatment, and shoulder range of motion at 12 months after diagnosis. Each unit increase in depressive symptoms at 2 months following diagnosis was associated with an 8 percent decreased odds of having full range of shoulder motion, after controlling for other relevant patient and treatment factors.

A large number of women were over 70 years old. Older women were more likely to have full shoulder range of motion than younger women. However, younger women were more often recruited from public hospitals, and their insurance may not have enabled them to use appropriate services to improve shoulder problems. White race, lack of disability in carrying out daily activities, and local breast cancer staging were associated with likelihood of having full range of shoulder motion at 12 months.

Women who did not receive radiation therapy, which can trigger the transformation and proliferation of fibroblasts (connective tissue cells), were also more likely to have full range of motion. Cognitive status, type of breast cancer surgery, dissection of axillary lymph nodes, and nurse case management did not significantly affect full shoulder range of motion. The study was supported in part by the Agency for Healthcare Research and Quality (HS11618).

See "The relationship between depressive symptoms and should mobility among older women: Assessment at one year after breast cancer diagnosis," by Mabel E. Caban, M.D., Dr. Freeman, Dong D. Zhang, Ph.D., and others, in the June 2006 Clinical Rehabilitation 20, pp. 513-522.

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