BCRL questionnaires: climate and indigenous groups

Health, Tropical Medicine and Rehabilitation Sciences, James Cook University; Professor Lorraine Sheppard is Professor of Physiotherapy, School of Health Sciences, University of South Australia and School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University; Anita Selby is Clinical Physiotherapist, Far North Queensland, Australia Breast cancer-related lymphoedema (BCRL) is a chronic, debilitating swelling of the upper limb which occurs secondary to medical intervention for breast cancer. Established risk factors include axillary lymph node dissection (ALND) (Levitt, 2000; Purushotham et al, 2005), adjuvant radiation therapy to the axilla (Senkus-Konefka and Jassem, 2006), increased body mass index (BMI) and older patient age (Kocak and Overgaard, 2000). Current prevention advice related to patient and lifestyle factors is largely anecdotal, with a poor evidence base (Nielsen et al, 2008). Climate is suggested to be a risk factor for the development of lymphoedema (Nielsen et al, 2008). Exposure to suggested risk factors, including heat, insect bites report participating less in outdoor activities such as family gatherings and daily walks, and decreased use of compression garments, or even stopping wearing them altogether. Heat has been identified in BCRL qualitative research as having detrimental effects in that it causes discomfort, selfconsciousness and hygiene issues, all of which have a negative impact on social aspects of quality of life (QoL) (Carter, 1997; Johansson et al, 2003; Fu, 2005; Ridner, 2005). A study undertaken in Germany, which is classified by Peel et al (2007) as having temperate and cold climates, reported compliance with wearing compression garments to be less than 30% (Bani et al, 2007). However, the effect of different climates on compliance with selfmanagement practices for BCRL has not been investigated.