This paper documents the validation of a quality of life scale (QOL) designed to assess the impact of arm morbidity on patients following breast cancer surgery. A four item arm subscale was developed to supplement a multi-dimensional, validated breast cancer QOL tool, the functional assessment of cancer therapy (FACT-B.) The new questionnaire, the FACT-B + 4, was validated on 279 women participating in a trial of sentinel node guided axillary therapy and 29 women attending a lymphoedema clinic. The subscale demonstrated good internal consistency (alpha co-efficient = 0.62 to 0.88) and stability (test-retest reliability = 0.97). Lymphoedema patients reported significantly greater arm problems than a matched sample of pre-operative trial participants. The lymphoedema group also scored lower than trial patients on the FACT-B + 4 indicating a poorer quality of life (p < 0.05). A subset of 66 trial patients who had completed three consecutive assessments was used to evaluate the sensitivity of the questionnaire to change over time. Scores on the FACT-B + 4 were found to decline significantly between the pre-operative assessment and post-operative assessment at 1 month. Arm problems significantly increased during this period. FACT-B + 4 score increased again from 1 month to 12 weeks post-surgery and symptoms reduced, as the extent of arm morbidity resolved. The FACT-B + 4 appears to be psychometrically robust and sensitive to patient rehabilitation, making it suitable for use in longitudinal surgical trials. Given the dearth of existing scales available to measure arm morbidity, we hope this new tool will prove useful to researchers.

Objective Prehabilitation is increasingly being used to mitigate treatment‐related complications and enhance recovery. An individual's state of health at diagnosis, including obesity, physical fitness and comorbidities, are influencing factors for the occurrence of adverse effects. This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post‐treatment and considers the utility of prehabilitation before cancer treatment. Methods A database search was conducted for articles published with prehabilitation as a pre‐cancer treatment intervention between 2009 and 2017. Studies with no 30 days post‐treatment data were excluded. Outcomes post‐prehabilitation were extracted for physical function, nutrition and patient‐reported outcomes. Results Sixteen randomised controlled trials with a combined 2017 participants and six observational studies with 289 participants were included. Prehabilitation interventions provided multi‐modality components including exercise, nutrition and psychoeducational aspects. Prehabilitation improved gait, cardiopulmonary function, urinary continence, lung function and mood 30 days post‐treatment but was not consistent across studies. Conclusion When combined with rehabilitation, greater benefits were seen in 30‐day gait and physical functioning compared to prehabilitation alone. Large‐scale randomised studies are required to translate what is already known from feasibility studies to improve overall health and increase long‐term cancer patient outcomes.

Undergoing diagnostic investigations for symptoms of breast disease constitutes an intensely stressful experience for any woman. The widespread use of contemporary fine-needle techniques throughout specialist breast clinics, whilst removing the necessity of hospitalization and general anaesthesia for many women, has introduced the notion of the 'waiting game'. The ability to ascertain definitive results within a matter of hours has led to diversification in the structure of diagnostic breast services; however, the significance of the 'waiting game' in terms of distress experienced by women has not been investigated. This paper systematically reviews the research that has explored psychosocial morbidity in this phase of the disease trajectory, and provides summative recommendations for further research.

Aim-To conduct a commissioned survey of multidisciplinary breast team members' expectations of their own and each other's roles in providing diVerent kinds of information to women with breast cancer. Design-Questionnaire based survey. Setting and participants-Health professionals from five multidisciplinary breast care centres within a Sussex health authority. Main outcome measures-Interdisciplinary awareness of informational roles played by diVerent team members. Results and conclusions-The results of the team survey suggest that, in most cases, health professionals fulfilled the roles expected of them by the team, with two or three individuals identified as the main providers of information for each topic. However, many more professionals were involved in major discussions without the team's knowledge. The professional consistently playing a major "unseen" role was the breast nurse specialist. (Quality in Health Care 2001;10:70-75) Keywords: multidisciplinary teamwork; breast cancer; communication Research in the primary health care setting highlights a number of benefits for professionals working within a supportive, well functioning team, including better mental health and increased team eVectiveness.1 Complex tasks are accomplished more easily when professionals within the health care teams have clear goals, are cooperative and mutually supportive of one another, and are aware of each other's role.2 3 In order to achieve this, team members need to be able to communicate clearly within and across the diVerent professional disciplines and with the patients. There is plenty of evidence from hospitals and medical defence organisations showing that poor communication in general results in complaints and litigation. 4 Inadequate communication between members of specialist cancer teams can lead to confusion for patients about diagnoses, prognoses, and future management plans. Not only does this cause unnecessary distress for patients, but the situation is also frustrating and professionally unrewarding for team members. 39% of senior oncology nurses and 25% of doctors attending our communication skills courses cited "communication with colleagues" among their most stressful and challenging concerns. 5In addition, poor communication and management skills training were identified as major factors leading to burn out and psychiatric morbidity in UK consultants. 6 Since publication of the Calman-Hine report concerning reorganisation of cancer services in the UK, many centres have adopted a multidisciplinary team (MDT) approach with the aim of providing the patient with the best care.7 The NHS Executive breast cancer guidelines and those of the Scottish Intercollegiate Network made explicit recommendations about the need for good communication between the healthcare professionals within an MDT, and between the MDT and patients.8 9 A well functioning MDT with good communication skills should prevent or ameliorate some of the problems experienced by patients and their professional carers through increased eYci...

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