Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BACKGROUND

Social anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.

METHODS

This study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.

RESULTS

The trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients' social anxiety (P < 0.05).

CONCLUSION

The trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

What is the relationship between body image and the quality of life of women who underwent surgery for breast cancer? A scoping review

PURPOSE

This review aimed to identify, characterize, map, and summarize existing knowledge about the relationship of perceived body image with the quality of life (QoL) of women who have undergone surgical treatment for breast cancer.

METHODS

A scoping review was conducted following the PRISMA-ScR guidelines. PubMed, PsycINFO and Scopus databases were searched, and articles published until August 2022 were included.

RESULTS

The search resulted in 796 records, and 51 articles were included for analysis. A significant negative impact on body image perception and QoL after surgical treatment for breast cancer was found in the majority of studies. Sociodemographic variables such as age, education, socioeconomic status, unstable attachment styles and time after the surgery may have an effect on a worsening of the overall body image and QoL score of women. It was found that there was greater dissatisfaction with body image in women who underwent mastectomy compared to those who underwent conservative surgery.

CONCLUSION

Evidence has shown that breast cancer surgery affects the perceived body image and QoL of patients worldwide. Age, education, socioeconomic status, and the type of surgery are potential factors influencing these outcomes. It is worth noting that the review encompassed articles from various countries, reflecting a significant cultural diversity among the studied populations. However, most of these articles did not delve into an analysis of these cultural disparities. This review also indicated insufficient details regarding the assessment instruments used to assess perceived body image.

Psychological Impact of Type of Breast Cancer Surgery: A National Cohort Study

Background

The present study assessed the impact of different types of breast surgery on rates of psychological disorders in breast cancer patients.

Methods

This nationwide cohort study, based on Korean Health Insurance Review and Assessment Service claims data, included 26,259 breast patients who underwent surgery from June 1, 2017, to December 31, 2018. Associations between the incidence of psychological disorders and variables were evaluated by time dependent Cox regression analyses.

Results

Of the 26,259 patients, 9394 (35.8%) underwent total mastectomy (TM) and 16,865 (64.2%) underwent partial mastectomy (PM); of the former, 4056 (43.2%) underwent breast reconstruction surgery (RS). A total of 4685 patients (17.84%) were newly diagnosed with psychological disorders after surgery. Multivariable analysis showed that axillary lymph node dissection was significantly associated with increased rates of overall psychological disorders (p < 0.0001), depression (p = 0.0462), anxiety (p < 0.0001) and insomnia (p < 0.0001). The rates of overall psychological disorders (p = 0.0002) and insomnia (p = 0.01) were significantly lower in patients who underwent TM than PM. RS tended to associated with reduced rates of overall psychological disorders in patients who underwent TM. Subgroup analysis showed that, compared with PM, RS after TM significantly associated with a reduced incidence of overall psychological disorders and insomnia in younger patients (< 50 years) and those who underwent sentinel lymph node biopsy.

Conclusion

In contrast to general belief, rates of overall psychological disorders and insomnia were lower in patients who underwent TM than PM. Moreover, RS after TM confers psychological benefit in younger patients with early stage breast cancer compared with PM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-022-06585-y.

Gender Comparison of Psychological Reaction Between Breast Cancer Survivors and Their Spouses

Background: Scant evidence exists among the different psychological issues between patients with breast cancer and their spouses. The objective of our study was to develop the measuring instrument testing psychological reaction and compare the difference in psychological reaction between patients with breast cancer and their spouses during the period of diagnosis and treatment. Method: The semi-structured interview guideline was guided by the psychological stress model. In-depth interviews were conducted among patients with breast cancer and their spouses. Qualitative data was used to establish the item pool for the psychological reaction. Delphi method was used for item modifications. The items were conducted to find common factors through exploration factor analysis. Comparing the differences of common factors through t-test between patients with breast cancer and their spouses. Results: Five couples were interviewed directed by the semi-structured interview guideline. About 38 items were reserved to formulate the questionnaire through the Delphi method. A total of 391 respondents (216 patients and 175 spouses) were recruited to complete the questionnaire. Two common structures were found through exploration factor analysis, which was named as reaction to role and body image change and negative coping reaction. The t-test found that the dimension of reaction to role and body image change (95% CI = 2.34-5.01, p < 0.001) reflects the difference between patients with breast cancer and their spouses. Conclusion: The reactions to role and body image change between patients with breast cancer and their spouses are different during the period of diagnosis and treatment. Clinical workers should pay attention to the different reactions and help couples deal with breast cancer smoothly.

Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study

Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

Subjective Well-Being and its Impact on Cancer-Related Fatigue in Patients Undergoing Radiotherapy and Long-Term Survivors

Objective: This study examines the profile of subjective well-being among 33 patients undergoing radiotherapy at the time of the study and 30 long-term survivors for over five years. A subject of the study is also the relation between the aspects of subjective well-being (life satisfaction, positive and negative affect) and the separate dimensions of fatigue and an analysis has been made of their influence on the burden of fatigue among the examined people.

Materials and Methods: A total of 66 cancer patients were enrolled in the study – 33 patients undergoing radiotherapy and 30 long-term survivors. Multidimensional questionnaire on fatigue MFI-20 and Scale for subjective well-being (SWLS) were used to assess Cancer-related fatigue (CRF) and Subjective well-being in patients during radiation-treatment and in long-term survivors. Data were analyzed using the Spearman Correlation analysis and t-test of Student. Linear regression analysis was performed to determine the predictors of fatigue score during radiation-treatment and long-term survivor cancer patients.

Results: Of all the components of subjective well-being, only life satisfaction and the positive affect showed a substantial relation with the five dimensions of fatigue, namely: general fatigue, physical fatigue, reduced activity, reduced motivation, mental fatigue. The burden of the physical and general fatigue among patients undergoing radiotherapy was estimated primarily based on the grounds of life satisfaction, (ß = -0.53; р = 0.03), respectively; (ß = -0.40; р = 0.01), the negative affect (stress) was a major predictor of the burden of general fatigue among patients belonging to the same group (ß = 0.33; р = 0.03). The positive affect predicts to a large extent the burden of the general (ß = -0.54; р = 0.02) and physical fatigue (ß = -0.36; р = 0.04) for the group of the long-term survivors for over five years.

Conclusions: In congruence with positive psychology, positive affect and life satisfaction, as aspects of subjective well-being, proved to be protective factors against the burden of fatigue. These results can guide the development of individually tailored interventions that may reduce the impact of fatigue on patients with cancer.

Prognostic factors associated with locoronal relapses, metastatic relapses, and death among women with breast cancer. Population-based cohort study

BACKGROUND

This study was designed to identify the prognostic factors associated with two types of relapses of breast neoplasms. The aim of this study was to evaluate the association between two possible relapses for the increased incidence of distant metastases observed in patients with local relapses injuries, using multivariate statistical models.

DESIGN

And Setting: A population-based cohort study that was designed as a single center: the cancer research center, Shahid Beheshti University of medical sciences.

METHODS

This study was conducted on 1815 patients with breast cancer having age of 22 or more. This study considers the analysis of recurrence and survival by joint modeling of three correlated outcomes: local recurrence, distant recurrence (metastasis) and death. The goals are to find out the effects of treatments on recurrences and death, the effects of relapses on death and the correlation between local and distant recurrences.

RESULTS

According to obtained results of the fitted models, the risk of local and metastatic relapses or death increased for patients with at least one positive lymph node (N+) or for patients with a grade greater than I. Also, the variable HR+ was significantly associated with the hazards of locoronal, metastatic recurrence and the death for both reduced and proposed models (P < 0.05).

CONCLUSIONS

We concluded that if the association between these outcomes are not taken into account, we may lose important information. Given the small number of recurrent events, these results should be considered with caution.

Assessment of Quality of Life of Women with Breast Cancer

Background:

Breast cancer is the most common type of cancer among women in 145 countries worldwide, and the success of healthcare for women with this disease is measured with the quality of life of survivors. The aim of this study was to examine how the breast cancer affects the quality of life and in what dimension of health quality of life is the least accomplished.

Method:

A pilot research had been performed in the period from June 10 to August 15 2011, on 100 women from Association of women with breast cancer “Iskra” in Banja Luka, aged 20-75. The survey research was based on the EORTC QLQ-C30 version 3.0 and questionnaire for assessment of quality of life of those suffering from breast cancer QLQ-BR23 with 53 questions in total.

Results:

The average age of women in research was 51.8 years (±11.23). Statistically important differences (χ²₄=221.941; p<0.01) are higher mean values of the score for the functional scale, (66.32±17.82) cognitive functions (63.50±28.00) in relation to functional role (46.83±20.88), social (37.00±27.58) and emotional (36.58 ±25.15) functioning. Mean values of the score for the symptoms scale were statistically higher for symptoms such as fatigue, insomnia and pain in relation to other symptoms. Mean values of the score for body image scale are statistically higher in relation to mean values of the score of sexual functions and enjoyment scale, and the scale for grading the future perspectives.

Conclusion:

Breast cancer affects all the domains of the quality of life, and in our population it is the most prominent in domains of emotional and social functions, as well as role functions. Symptoms of fatigue, insomnia and pain have the most importance influence on these domains.

The adaptation process of a teaching and research hospital to changing trends in modern breast surgery

OBJECTIVE

Minimally invasive surgery is increasingly gaining importance in breast surgery parallel to other surgical branches. Sentinel lymph node biopsy (SLNB) is a method that has radically changed the approach to breast surgery in the last decade of the 20(th) century. In this study, we aimed to evaluate the adaptation process to these alterations in breast surgery at our clinic.

MATERIAL AND METHODS

Patients who underwent surgery with a diagnosis of breast cancer in our clinic between April 2010 and November 2013 were retrospectively evaluated in terms of demographic characteristics, the number of operations and type of surgical methods applied according to years, SLNB performance rate, and results of frozen section and histopathological analysis. The first year of SLNB practice was accepted as part of the learning curve, and 24 patients who were operated during that period underwent routine axillary dissection.

RESULTS

The median age of 198 patients who were included in the study was 55 years (25-89). It was detected that the number of cases who underwent surgery for breast cancer increased in years, that the SLNB application rate increased from 37% to 66% between 2010 and 2013 (p=0.01), and SLNB staining rates increased from 70% to 94% (p=0.03). When only results from the last four years were evaluated, the mean staining rate in patients with SLNB (n=105) was 88% (n=92), with positive histopathology in 32% of these cases (n=30). Despite a decreasing trend over the years, a metastatic axillary lymph node was detected in paraffin block evaluation in spite of negative frozen section examination of SLNB in five cases, and 5 patients (5%) out of 97 patients who underwent breast conserving surgery required re-excision. The histopathological diagnosis was invasive ductal carcinoma in 84% (n=167) of patients.

CONCLUSION

It was observed that during the four-year period of adaptation, the application rate of breast conserving surgery and SLNB reached accepted standards, and that both the technical problems encountered in SLNB and the requirement for re-excision after breast conserving surgery significantly decreased with increasing case volume and experience.

Quality of life among women treated for breast cancer: a survey of three procedures in Mexico

BACKGROUND

This study aimed to determine the quality of life among patients treated with one of three different types of surgery for breast cancer.

METHODS

This cross-sectional study used a questionnaire survey completed by Mexican patients without active disease 1 year after breast cancer surgery.

RESULTS

The 139 patients enrolled in the study included 44 (31.6 %) who had undergone mastectomy with reconstruction, 41 (29.5 %) who had undergone a quadrantectomy, and 54 (38.9 %) who had undergone radical mastectomy without reconstruction. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, core version 30 (EORTC QLQ-C30) and EORTC Breast Quality-of-Life Questionnaire (QLQ-BR23) questionnaires were used. These instruments had a reliability greater than 0.82. Global health status (94.30 ± 12.04; p = 0.028) and role functioning (85.16 ± 17.23; p = 0.138) were highest in the quadrantectomy group. The pain score was highest in the group that had received mastectomy with reconstruction (26.13 ± 30.15; p = 0.042). The breast symptom score (22.56 ± 22.30; p = 0.009) and body image perception (85.56 ± 19.72; p = 0.025) were highest in the group that had conservative treatment. The overall health of the patients who had undergone mastectomy without reconstruction was lower (72.61 ± 20.89; p = 0.014) among the women older than 50 years than among the younger women.

CONCLUSIONS

The quadrantectomy procedure had better acceptance, but the overall health status did not differ between the groups. The overall health status was lower among the women older than 50 years who had received a mastectomy without reconstruction.

Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura

A mulher passa por um importante processo de reformulação da imagem corporal quando lida com o câncer de mama. Este artigo objetiva a compreensão da relação que o câncer de mama e seus tratamentos têm no processo de (re)elaboração da imagem corporal das mulheres, visando assim ao fomento de subsídios para a formação e a capacitação de profissionais de saúde mais atentos à promoção da qualidade de vida delas. Foi realizada uma revisão sistemática da literatura de artigos científicos publicados entre 2004 e 2009 disponíveis em três bases de dado; 56 artigos foram revisados e agrupados em quatro categorias. Destacamos a necessidade de mais estudos que contemplem características socioculturais de mulheres com câncer de mama, sobre diferenças na (re)elaboração da imagem corporal de mulheres jovens e de mulheres mais velhas, e de publicações brasileiras sobre a experiência pessoal e aspectos socioculturais específicos de mulheres com câncer de mama.

Breast carcinoma in Chinese women: does age affect treatment choice and outcome?

OBJECTIVE

Age is a known risk factor for breast cancer behaviour. We studied the relationship of age with clinical characteristics, tumour pathology, therapeutic options and outcome in an affluent Asian population.

METHODS

From 2003 to 2008, data on newly diagnosed breast carcinoma patients under the care of the multidisciplinary breast cancer team based at a private hospital in Hong Kong were collected prospectively. Patients were divided into three groups: age < 40 years (group I), 41-69 years (group II), and ≥ 70 years (group III).

RESULTS

There were 2,079 patients: 334 in group I, 1,538 in group II and 148 in group III. The clinical presentation and tumour stages were similar. Younger patients had higher tumour grading (p = 0.000) and more lymphovascular permeation (p = 0.011). For older patients, combination therapy was employed less frequently (p < 0.0005), and more radical resection with less reconstructive procedures were performed (p = 0.000). The 3-year disease-free survival was 97.8% and there was no difference between the three groups.

CONCLUSION

Although breast cancer in younger Chinese patients was more aggressive pathologically, the differences between clinical presentation, tumour staging and survival were similar. Treatment strategies should follow the clinical condition of the patient rather than age alone.

Body Image Perception and Quality of Life in Patients who Underwent Breast Surgery

Quality of Life (QoL) has become a standard measure in assessing the effectiveness of medical interventions. We compared the differences between QoL and body image scale (BIS) in a group of patients who underwent breast surgery, including lumpectomy or conservative surgery, modified radical mastectomy and radical mastectomy with breast reconstruction. We included patients who underwent breast surgery between August of 2005 and June of 2006 in two tertiary referral centers in Mexico City. Two self-administered questionnaires assessing body image perception, BIS and quality of life (SF-36), were assigned and a physician-conducted interview was done. We stratified patients by age, marital status, and scholar grade. The sample comprised 202 patients. The BIS results yielded: the group with a benign lesion demonstrated favorable body image perception when compared with the malignant lesion group. A confirmed diagnosis of malignancy hinders QoL in older and younger age groups. Conservative surgery and breast reconstruction improves QoL in younger patients without significance in the older group. The most significant variable that hinders the BIS and QoL is the cancer diagnosis. Impact of conservative surgery and breast reconstruction in body image perception and quality of life is influenced by patient age and educational level.

Depression and conservative surgery for breast cancer

BACKGROUND

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS

Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

Impact of Breast Cancer Surgery on the Self-Esteem and Sexual Life of Female Patients

Patient satisfaction with cosmetic outcome and the psychological impact of breast cancer surgery were evaluated. A total of 207 patients with primary breast cancer, treated with either breast-conserving surgery ( n = 83), modified radical mastectomy without reconstruction ( n = 108), or mastectomy with delayed breast reconstruction ( n = 16) rated their cosmetic outcome and satisfaction following surgery, and the impact of surgery on their self-esteem and sexual life, by questionnaire. Patients undergoing breast-conserving surgery were most satisfied with their surgery and body image, followed by those treated with mastectomy with delayed reconstruction. Although diagnosis of breast cancer had a negative impact on the psychology of all patients, those undergoing breast-conserving surgery or mastectomy with delayed reconstruction were more satisfied and reported a lower impact on their self-esteem and sexual life versus those who only had mastectomy. Diagnosis of breast cancer has a negative psychological impact on the patient, but the type of surgery has a significant role in post-operative self-esteem and sexual life.

Physical activity behaviors in women with newly diagnosed ductal carcinoma-in-situ

Epidemiological evidence suggests that physical activity may affect breast cancer risk and other health outcomes. Little information is available regarding changes in activity after diagnosis and treatment of in-situ cancer. We enrolled 487 women with newly diagnosed ductal carcinoma-in-situ (DCIS) in a longitudinal cohort study. Exercise behaviors were assessed at enrollment and at 18 months. Changes in exercise frequency over time were compared, and the impact of demographic and treatment-related variables was evaluated. Enrollment and 18-month exercise data were available for 391 women (80%). At enrollment, most women performed strenuous physical activity infrequently, and only half engaged in any type of exercise more than twice a week. Overall activity patterns did not change greatly over the course of the study. However, logistic regression modeling of changes in exercise revealed that women who underwent unilateral or bilateral mastectomy (hazard ratio [HR], 2.4; 95% confidence interval [95% CI], 1.3-4.4) and those who were anxious at enrollment (HR, 2.1; 95% CI, 1.1-4.1) were statistically significantly more likely to decrease exercise levels, and women who worked were significantly more likely to increase exercise over the course of the study (HR, 1.9; 95% CI, 1.1-3.3). Nonsignificant variables included age, reconstructive surgery, depressive symptoms, financial status, education, and tamoxifen use. A large proportion of women with newly diagnosed DCIS were inactive and remained so over time. Women who underwent mastectomy, as well as women who were more anxious, were more likely to decrease their level of physical activity. Women with DCIS might benefit from targeted interventions to increase physical activity.

Axillary surgery in breast cancer patients

Surgeons have routinely removed ipsilateral axillary lymph nodes from women with breast cancer for over 100 years. The procedure provides important staging information, enhances regional control of the malignancy and may improve survival. As screening of breast cancer has increased, the mean size of newly diagnosed primary invasive breast cancers has steadily decreased and so has the number of women with lymph node metastases. Recognising that the therapeutic benefit of removing normal nodes may be low, alternatives to the routine level I/II axillary lymph node dissection have been sought. A decade ago sentinel lymph node biopsy (SLNB) was introduced. Because of its high accuracy and relatively low morbidity, this technique is now widely used to identify women with histologically involved nodes prior to the formal axillary node dissection. Specifically, SLNB has allowed surgeons to avoid a formal axillary lymph node biopsy in women with histologically uninvolved sentinel nodes, while identifying women with involved sentinel nodes who derive the most benefit from a completion axillary node dissection. Despite the increasing use of SLNB for initial management of the axilla in women with breast cancer, important questions remain regarding patient selection criteria and optimal surgical methods for performing the biopsy. This article discusses the evolution of axillary node surgery for women with breast cancer.