Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress

Sometimes it is better to just make it simple. De-escalation of oncoplastic and reconstructive procedures

Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.

Effect of a social network-based supportive program (WhatsApp) on the sexual self-concept of women with breast cancer: A single-blind-randomized controlled trial

OBJECTIVES

Sexual self-concept has an influence on the sexual behaviors of women with breast cancer. Supportive programs for these women have demonstrable empirical efficacy; however, their effectiveness has not been examined. The aim of this study was to investigate the effect of a supportive program based on social networks on the sexual self-concept of women with breast cancer.

METHODS

In this randomized controlled single-blind trial, 60 women were assigned to the intervention (n = 30) and control (n = 30) groups using permuted block randomization. Overall, eight 45-min intervention sessions were held (twice a week). The primary outcome was sexual self-concept, and the secondary outcomes were women's sexual quality of life and participants' satisfaction. The questionnaires were completed by patients before the intervention and immediately and 1 month after the intervention.

RESULTS

The generalized equation estimation test showed that the positive sexual self-concept score of the intervention group versus the control group had increased by 15.67 points (P < 0.001, effect size = 2.00) 1 month after the intervention. The negative sexual self-concept score had decreased by 2.65 points (P < 0.001, effect size = 0.74), and the situational sexual self-concept score had upturned by 6.82 points (P < 0.001, effect size = 2.08) in the intervention group at the same period. Also, the sexual quality of life score in the intervention group compared to the control group generally increased by 13.82 points (P < 0.001, Effect size = 2.08) 1 month following the intervention.

SIGNIFICANCE OF THE RESULTS

A social networking support program can be a promising approach to improve the sexual self-concept of women with breast cancer.

CLINICAL TRIALS.GOV IDENTIFIER

Iranian Clinical Trial Register, IRCT20150608022609N8. Registered on 2 July 2020.

Effects of Cimicifuga racemosa (L.) Nutt on sexual function in women receiving tamoxifen for breast cancer

To assess the effects of Cimicifuga racemosa (L.) Nutt on climacteric symptoms and sexual function in women receiving tamoxifen after breast cancer treatment. A prospective study of women treated at the Mastology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Santa Casa de Sao Paulo School of Medical Science of the hospital was conducted between 2018 and 2021. Patients diagnosed with breast cancer that underwent surgical, radiotherapy and chemotherapy treatment more than one year prior, receiving tamoxifen, exhibited climacteric symptoms and were sexually active were selected. Total of 34 women were recruited and during outpatient visits completed sociodemographic questionnaire, Blatt-Kupperman Index (KI) and Female Sexual Function Index (FSFI). The group showed improvements in climacteric symptoms (p<.001) and sexual function (p=.011) after the 6-month follow-up. Cimicifuga racemosa (L.) Nutt promoted improvements in climacteric symptoms and sexual function in women surgically treated for breast cancer. Clinical Trials.gov ID: NCT02467686.Impact StatementWhat is already known on this subject? The medications used for the treatment of breast cancer can lead to important complaints of vasomotor manifestations with a negative impact on the success of their treatment, and cases have been described until their interruption. Cimicifuga racemosa (L.) Nutt. is described in several works as a therapy to alleviate these symptoms. Numerous works in the literature present climatic symptoms and sexual function with a selective approach to the themes.What do the results of this study add? Our study evaluated a group of women who were treated for breast cancer after menopause taking into account the following aspects: climacteric symptoms and sexual function. When we reviewed the literature, we did not find, so far, work similar to ours.What are the implications of these findings for clinical practice and/or further research? In clinical practice, assessing vasomotor symptoms and sexual response of breast cancer patients can contribute towards improving the lives of this patient group. Prescribing Cimicifuga racemosa (L.) Nutt in cases with climacteric complaints and poor sexual response can relieve distress and promote better health and life status for these women. Although the present investigation has generated important data on female breast cancer survivors, there are limitations regarding the number of participants. We recommend further clinical research with expansion of the sample studied and the results presented.

Prospective examination of psychological risk and maintenance factors for body image distress after mastectomy with immediate breast reconstruction

Reconstructive breast surgery aims to improve body image following mastectomy, yet many women experience ongoing body image distress (BID). The relationship between the esthetic outcome of reconstructive surgery with BID has been underexplored in mastectomy. This study aimed to assess whether reconstruction outcome following mastectomy is associated with post-surgery BID, and to examine potential psychological risk and maintenance factors for BID above reconstruction outcome. In 49 women undergoing mastectomy with immediate breast reconstruction, we prospectively assessed hypothesized pre-surgery psychological risk factors and post-surgery maintenance factors for post-surgery BID. Reconstruction outcome was assessed via blind surgeon ratings of post-surgery photographs. Surgeon-rated reconstruction outcome was uncorrelated with BID, or with patients' ratings of surgical outcome. Higher pre-surgery depressive symptoms and lower pre-surgery patient expectations for reconstruction predicted greater post-surgery BID, above reconstruction outcome. Post-surgery body checking also predicted greater BID, above reconstruction outcome. Results suggest that the medical team cannot assume their perception of reconstruction outcome matches the patient's view or degree of BID. If replicated, results point to potential psychological risk and maintenance factors that are stronger predictors of post-reconstruction BID, highlighting opportunities for light-touch prevention and intervention to reduce BID after mastectomy with breast reconstruction.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery

Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app. In phase 1, a prototype app called Pink Journey for use on the iPhone OS (IOS) platform was created following the framework of shared decision making. In phase 2, 11 women who were given the option of reconstruction by a breast surgeon were recruited from July 2017 to December 2017. A pretest-posttest design was adopted to test the usability and feasibility of the app. The results showed that the women who used the app reported significantly less decisional conflict after intervention on each subscale of the Decision Conflict scale, i.e., "being informed", "uncertainty", "social support", "effective decision", and "value clarification". This research provides preliminary data indicating that Pink Journey holds promise for decreasing decision conflict. Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.

Patient satisfaction after breast cancer surgery : A prospective clinical trial

BACKGROUND

This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL).

METHODS

In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT).

RESULTS

Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert (p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge (p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher.

CONCLUSION

Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.

Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis

The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI-confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI -0.07, 0.37), emotional health (k = 13; -0.08, 95% CI - 0.41, 0.25), global health (k = 7; 0.1, 95% CI - 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI - 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.

"Every part of me has changed"-shared lived experiences of adolescents living with cancer in Zambia

This study explored experiences of adolescents living with cancer, focusing on physical and psychosocial problems. Semi-structured interviews were carried out on 18 adolescents aged between 12 and 18 years. Transcripts were analyzed using thematic analysis. Results showed that the adolescents faced a lot of physical, psychological, and social problems due to cancer diagnosis, treatment, and care. In order to improve their well-being and quality of life, psychosocial interventions should be incorporated in biomedical interventions that adolescents with cancer receive. This study proposes cost-effective interventions that can be implemented in resource-restricted sub-Saharan countries like Zambia.

Breast Reconstruction After Mastectomy: A Survey of Surgeons' and Patients' Perceptions

BACKGROUND

Breast reconstruction after mastectomy is important in breast cancer care.

MATERIALS AND METHODS

A cross-sectional study was designed to assess surgeons' and patients' perceptions toward breast reconstruction. Questionnaires were distributed to general and breast surgeons in East Coast Malaysian hospitals and Hospital Kuala Lumpur and to postmastectomy patients with and without breast reconstruction at the Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. The response rates were 82.5% for the surgeons (n = 33), 95.4% for the patients with reconstruction (n = 63), and 95.5% for the patients without reconstruction (n = 278).

RESULTS

The median surgeon age and experience was 42 and 6 years, respectively. Each surgeon saw an average of 20 new breast cancer cases annually. Most surgeons (86.7%) discussed reconstruction options with their patients but had only referred an average of 4 patients for reconstruction during a 3-year period. Surgeons' concerns regarding the qualitative outcome increased the likelihood of a breast reconstruction discussion (β = 4.833; P = .044). The women who underwent breast reconstruction were younger (mean age, 42 vs. 50 years), were more often working (69.4% vs. 42.2%), and more often had previous awareness of the option (90.3% vs. 44.3%). The most common reasons for undergoing breast reconstruction were "to feel more balanced" (92.1%) and "surgeon's strong recommendation" (92.1%). Previous knowledge of breast reconstruction increased the likelihood of reconstruction (odds ratio, 5.805; P = .026). Although 70% of surgeons thought that patients would not be interested in reconstruction, only 37.9% of patients with previous awareness reported having no interest.

CONCLUSION

The low reconstruction rate (20.6%) can be attributed to the low referral rate. Patients' likelihood to undergo reconstruction with their surgeon's recommendation and with previous awareness were reflective of the surgeons' strong influence on their patients. Thus, clarification of surgeons' hypothetical criticisms could conceivably increase the reconstructive surgery rate.

Factors Affecting Psychosocial Adjustment in Patients with Surgical Removal of Benign Breast Tumor

PURPOSE

To identify factors influencing psychosocial adjustment in patients with surgical removal of benign breast tumor.

METHODS

With a survey design, data were collected using the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), Body Image Scale, Physical Discomfort Scale, and Family Support Scale with patients who had had surgical removal of a benign breast tumor from September to November 2017. Data were analysed with descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression.

RESULTS

The mean scores for physical discomfort, body image, family support, and psychosocial adjustment were 1.57±0.51, 0.37±0.64, 3.62±0.67, and 4.00±0.45, respectively. Family support, body image, physical discomfort, number of surgical removal of benign breast tumor (twice), and cancer insurance status (yes) were verified as factors influencing psychosocial adjustment. These factors accounted for 57.4% of psychosocial adjustment.

CONCLUSION

In this study, family support, body image, and physical discomfort were identified as significant predictors of psychosocial adjustment. Therefore, this study can be used as fundamental data to develop nursing intervention strategies in order to increase psychosocial adjustment in patients with surgical removal of a benign breast tumor.

Immediate Breast Reconstruction

This article represents findings of a qualitative analysis of interviews with women age 30 to 64 years ( n = 14) who had undergone immediate breast reconstruction (IBR) following mastectomy. The purpose of the study was to explore women’s experiences for electing IBR. According to our analysis, women experienced mastectomy as a disability, and their expectations of IBR to restore their sense of normalcy were not fulfilled. Most women perceived the reconstructed breast mainly as a visual replacement. Women’s experience formed a continuous narrative from the moment of diagnosis, through mastectomy until the completion of the reconstruction.

Breast Cancer as an Embodied Life Event: A Synthesis of Research and Theory and Directions for Intervention and Future Work

With the present work, we reviewed literature exploring breast cancer and body image and invoked this synthesis as a platform from which to develop (a) theoretical applications for understanding the embodied experience of breast cancer, (b) implications for counseling interventions, and (c) recommendations for continued research. Of particular relevance to our analyses was theory related to the social construction of the female body and also theories related to meaning-making, illness, and loss. Based upon our synthesis, we suggest a counseling approach in which professionals treating breast cancer patients listen for and attend to breast cancer patients' attributions of meaning and consider the varied influences that may contribute to those meanings. Additionally, we propose that researchers invoke qualitative approaches and social constructionist/meaning-making perspectives to build understanding about the ways in which a woman's social roles, embodied history, world views, and other contextual factors shape her embodied experience of breast cancer.

Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research

OBJECTIVE

To gain a holistic and deep understanding about how mastectomy effects the body image of women who have breast cancer.

MATERIALS AND METHODS

The sample of this qualitative descriptive study consisted of twenty patients who underwent mastectomy procedures. Semi-structured interviews were conducted during the second week after mastectomy. Each interview was transcribed verbatim, and a thematic analysis was performed.

RESULTS

After the mastectomy, the findings related to the women's body image and their experiences were specified as four main themes and seven sub-themes. The main themes were: meaning of the breast, mastectomy and me, my body image and body image changes, and social life. Most of the participants in this study stated that the breast meant femininity, beauty, and motherhood. It was found that the meaning of mastectomy varied according to individuals. Women used quite negative statements about their appearances. The participants also said that they felt that half themselves was missing, as individuals and women. The women stated that they preferred clothes that hid their lack of breast. Some of the participants mentioned that relations with their husbands were not like before, and they abstained from social interaction.

CONCLUSION

Our findings suggest that mastectomy as a surgical treatment for breast cancer may negatively affect a woman's body image and her self-image.

Psychological Adjustment to Breast Cancer

Breast cancer remains a highly prevalent and extraordinarily stressful experience for hundreds of thousands of women each year in the United States and around the world. Psychological research has provided a picture of the emotional and social impact of breast cancer on patients’ lives, and of factors associated with better versus worse adjustment. Psychosocial interventions have been beneficial in decreasing patients’ distress and enhancing their quality of life. Recent research also suggests that psychological factors may be related to potentially important biological disease-related processes. In addition to providing an understanding of the psychological factors in breast cancer, research in this area has provided a framework for research on adaptation to health-related stress in general.

The Psychosexual Impact of Partial and Total Breast Reconstruction: A Prospective One-Year Longitudinal Study

BACKGROUND

This prospective trial sought to explore patients' satisfaction and expectations for surgery in the areas of sexuality and body image and to evaluate outcomes pertaining to sexual well-being after total and partial breast reconstruction (BR).

METHODS

Patients who underwent mastectomy and immediate total BR (group 1; n = 60) or lumpectomy and reduction mammoplasty (group 2; n = 10) completed a questionnaire preoperatively and 1 year postoperatively to assess their satisfaction with their sex life and body image, perceptions of breasts as a source of sexuality, and expectations of surgery in these areas. Surveys were scored on a 5-point Likert scale, with 5 indicating strongly agree. Change scores were evaluated in the 2 groups (P = 0.05).

RESULTS

In group 1, satisfaction with sex life and body image was unchanged. Pursuit of sexual attractiveness (from 3.78 to 3.31, P = 0.02) and an improved body image (from 3.89 to 3.33, P < 0.01) were cited as expectations for surgery but were achieved less often. When stratified by different types of reconstruction, there were no discernible differences in responses. In group 2, the patients reported an unexpected increase in their partner's perception of them as womanly (from 1.33 to 2.50, P = 0.01) and greater gains in the ability to wear sexually provocative clothing (from 1.78 to 3.11, P < 0.01).Preoperative expectations for improved body image were more often met in group 2 than group 1 (from 3.60 to 4.00 vs from 3.89 to 3.33, P = 0.02). Group 2 experienced greater improvement in body image satisfaction (from 2.80 to 3.80 vs from 3.37 to 3.44, P = 0.03).

CONCLUSIONS

Overall satisfaction with sex life and body image was preserved for both groups; however, the oncoplastic approach achieved significantly larger gains in body image perception.

[Evaluation of the impact of breast reconstruction in women in couple through a community-based research tool: The Seintinelles]

This preliminary study explores the psychological and marital impact of breast reconstruction (or lack thereof) in women who had a mastectomy due to breast cancer. The study was carried out through an innovative and French community-based research tool on cancer: the Seintinelles. Sixty-nine partnered women treated for breast cancer participated, divided into 3 groups: 19 without breast reconstruction, 24 with immediate breast reconstruction and 26 with delayed breast reconstruction. They completed online questionnaires measuring both satisfaction and regret about the decision related to breast reconstruction, quality of life after breast surgery (EORTC-BRR), emotional state (POMS) and marital intimacy (PAIR). Recruitment through the Seintinelles had the advantage of being quick and national, but the profile of participants deviated from the mean population in the sense that our subjects were on average younger than women affected by breast cancer and had faced more breast cancer in their family. The results revealed that women are satisfied with their choice (little regret), have a similar emotional experience and good marital intimacy. However, women without breast reconstruction would less recommend their decision to others and were less satisfied with the aesthetic result, compared to women with breast reconstruction. These results highlight that psychological and marital impact seems comparable in women with and without reconstruction. Future studies are needed to better understand the role of the partner in the recourse of breast reconstruction.

Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women's Choices for Mastectomy and Breast Conserving Surgery

One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area.

Evaluation of Social Support, Quality of Life, and Body Image in Women with Breast Cancer

BACKGROUND

This study was aimed at comparing the quality of life, body image, and perceived social support in women with breast cancer surgery.

PATIENTS AND METHODS

Patients receiving breast-conserving surgery (BCS) (n = 72), mastectomy alone (n = 44), and mastectomy with breast reconstruction (n = 41) were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Breast Cancer Module (QLQ-BR23), the Body Image Scale (BIS) and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

The results indicated that the BCS group had a better body image compared with the other 2 groups and better role functioning compared with the mastectomy-alone group. In the reconstruction group, body image correlated with perceived social support, especially from family and significant others.

CONCLUSION

These results suggest that a positive perception of a supportive social network can help women with breast reconstruction to better cope with the psychological effects of surgery on their body image.

An Interpersonal Investigation of Sexual Self-Schemas

A sexual self-schema is a cognitive generalization about sexual aspects of the self. In the current study, we examined how an individual's sexual self-schema influenced the processing of self and partner related sexual information. Specifically, we investigated how sexual self-schemas related to own and partner sexual satisfaction and how they influenced perceptions of partner sexual satisfaction. Participants were 117 heterosexual couples in committed, long-term relationships. Both partners completed measures assessing their sexual self-schemas, their own sexual satisfaction, and perceptions of partner sexual satisfaction. Consistent with our predictions, own sexual schema was associated with own sexual satisfaction. For men, more positive sexual self-schemas were associated with greater sexual satisfaction, and for women, more negative sexual self-schemas were associated with lower sexual satisfaction. For both men and women, there was no significant association between own sexual self-schema and partner sexual satisfaction. Sexual self-schemas directly and indirectly influenced an individual's perception of the partner's sexual satisfaction, such that men and women with more positive sexual self-schemas rated their partners as more sexually satisfied, after controlling for the partner's self-reported level of sexual satisfaction. Our findings demonstrated that sexual self-schemas are relevant to own sexual satisfaction as well as the processing of interpersonally relevant sexual information, specifically one's perceptions of partner sexual satisfaction.

Same Quality of Life for Polish Breast Cancer Patients Treated with Mastectomy and Breast Reconstruction or Breast-Conserving Therapy

Breast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations.

was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction.

The study involved women who underwent surgery for breast cancer in the Department of Surgical Oncology of the Gdynia Oncology Center from September 2010 to November 2013. Eighty-two breast reconstructions (in 79 patients) and 226 BCT procedures were performed. QoL was measured with the use of EORTC QLQ-C30 and QLQ-BR23 questionnaires.

Global QoL was high in both groups and did not differ significantly. Body image was slightly better after BCT than after mastectomy with breast reconstruction, but sexual QoL was lower. Future perspective was quite low in both groups. Disease symptoms were not bothering.

The global QoL among Polish breast cancer patients treated with BCT or mastectomy with breast reconstruction is high and does not differ between groups. There is a need for anxiety and disease-related fear prophylaxis and for the improvement of sex life of breast cancer survivors.

The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC)

INTRODUCTION

Adolescents and young adults aged 15-39 years who have been diagnosed with cancer (AYAC) have unique medical and psychosocial needs. Following their cancer treatments, AYAC must learn to manage the sometimes irreversible general side effects of cancer treatments including side effects that impact their sexuality. These side effects include but are not limited to: infertility, altered body/physical appearance, and sexual dysfunction. Such effects may hinder AYAC efforts to date and experiment sexually, limiting sexual maturation and confidence, as well as the formation or maintenance of meaningful couple and sexual relationships. It is clear that we need to tailor our clinical approaches to ensure that we assess the unique needs and concerns faced by AYAC.

AIMS

Based on consistent study findings substantiating the distinctive needs of AYAC, the main objective of this article is to present the core clinical components involved in assessing sexuality among AYAC.

METHODS

The clinical recommendations are based on the authors and experts' clinical experiences coupled with a thorough examination of the literature related to AYAC sexuality.

MAIN OUTCOME MEASURES

This article first describes the three components (clinical interview, review of chart notes, and self-report questionnaires) of a sexuality assessment and the seven core domains that highlight target areas of focus.

RESULTS

A detailed outline of each of the core domains of assessment (socio-demographics; medical history; fertility and sexually transmitted infection; sexual functioning; sexual coping style; body and self-image; and sexual history and dating/couple experience) is presented. A "toolbox" table containing useful resources for clinicians (e.g., questionnaires and red flags) and direct resources for AYAC patients are included.

CONCLUSION

Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care.

Breast cancer-related lymphedema and sexual experiences: a mixed-method comparison study

OBJECTIVE

Up to 40% of breast cancer survivors develop lymphedema, a chronic and sometimes disabling condition that manifests as abnormal swelling of the effected arm or hand or upper chest areas. Although the effects of lymphedema on quality of life have been well established, less well documented are the sexual experiences of breast cancer survivors with lymphedema. This study is the first to compare the sexual experiences of women with (n = 243) and without breast cancer-related lymphedema (n = 109).

METHODS

A mixed-method design was used to explore both quantitatively and qualitatively the impact of lymphedema on participants' sexual experiences.

RESULTS

Participants with breast cancer-related lymphedema reported struggles with compression garments and sexual intimacy, negative feelings involving the breast and arm, and feelings of decreased sexual desire.

CONCLUSIONS

Recommendations for healthcare professionals, social workers, and marriage and family therapists are offered with the aim of assisting women with breast cancer-related lymphedema and their sexual partners.

Patient-reported outcome measures in reconstructive breast surgery: is there a role for generic measures?

BACKGROUND

Patient-reported outcomes provide an invaluable tool in the assessment of outcomes in plastic surgery. Traditionally, patient-reported outcomes have consisted of either generic or ad hoc measures; however, more recently, there has been interest in formally constructed and validated questionnaires that are specifically designed for a particular patient population. The purpose of this systematic review was to determine whether generic measures still have a role in the evaluation of breast reconstruction outcomes, given the recent popularity and push for use of specific measures.

METHODS

A systematic review was performed to identify all articles using patient-reported outcomes in the assessment of postmastectomy breast reconstruction. Frequency of use was tabulated and the most frequently used tools were assessed for success of use, using criteria described previously by the Medical Outcomes Trust.

RESULTS

To date, the most frequently used measures are still generic measures. The 36-Item Short-Form Health Survey was the most frequently used and most successfully applied showing evidence of responsiveness in multiple settings. Other measures such as the Hospital Anxiety and Depression Scale, the Hopwood Body Image Scale, and the Rosenberg Self-Esteem Scale were able to show responsiveness in certain settings but lacked evidence as universal tools for the assessment of outcomes in reconstructive breast surgery.

CONCLUSIONS

Despite the recent advent of measures designed specifically to assess patient-reported outcomes in the breast reconstruction population, there still appears to be a role for the use of generic instruments. Many of these tools would benefit from undergoing formal validation in the breast reconstruction population.

Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors

PURPOSE

The aims of the study were (1) to understand the relationship between women's marital coping efforts and body image as well as sexual relationships and (2) to test a hypothesized model suggesting that marital coping efforts have a mediating effect on the relationship between body image and sexual relationships among breast cancer survivors.

METHODS

A total of 135 breast cancer survivors who had finished cancer treatment completed a self-reported questionnaire concerning body image, marital coping efforts, and sexual relationship.

RESULTS

Body image, marital coping, and sexual relationship were found to be significantly correlated with each other. The final path model showed that negative marital coping efforts, including avoidance and self-blame, significantly mediated the effect of women's body image on their sexual relationships. Although a positive approach did not correlate with body image, it did significantly correlate with women's sexual relationships.

CONCLUSIONS

Our study demonstrated that negative marital coping using self-blame and avoidance mediated the association between body image and sexual relationship. Future interventions to address the body image and sexual life of breast cancer survivors should be considered using positive approaches that prevent disengaged avoidance or self-blame coping efforts intended to deal with marital stress.

Identification of complications in mastectomy with immediate reconstruction using tissue expanders and permanent implants for breast cancer patients

BACKGROUND

Since complications of postmastectomy breast reconstruction may reduce patient satisfaction, we investigated complications of reconstruction with tissue expanders (TEs), particularly surgical site infections requiring TE/permanent implant (PI) removal.

PATIENTS AND METHODS

A retrospective review was performed of 234 primary breast cancer patients undergoing 239 postmastectomy breast reconstructions with TEs/PIs from 1997 to 2009. Clinicopathological findings and postoperative complications, particularly infections, were analyzed. Data were analyzed by the Chi-square test and a multivariate logistic regression model. TE infection risk factors considered for model inclusion were excisional biopsy, (neo) adjuvant chemotherapy, lymph node resection, body mass index (BMI), simultaneous bilateral reconstructions, and seroma aspiration.

RESULTS

Removal of TEs/PIs was observed in 15.5% (37/239) of reconstructions, and 18/37 underwent re-reconstructions. Of the 19/37 reconstructions that were not achieved completely, the most frequent reason was TE infection (11 reconstructions). The completion rate was 92% (220/239 reconstructions) and it was significantly higher in reconstructions without TE infection than with infection (96 vs. 54%, p < 0.0001). Patients with BMI ≥ 25 kg/m² and seroma aspiration were more likely to develop TE infections (p = 0.0019, p < 0.001, respectively). By multivariate logistic regression analysis, seroma aspiration was a significant independent risk factor for TE infection (odds ratio 28.75, 95% confidence interval 5.71-40.03, p < 0.0001).

CONCLUSION

To improve completion rates of breast reconstruction, prevention of TE infection plays a key role. We should reduce unnecessary seroma aspirations and delay elevation/exercise of the ipsilateral arm.

Sexualidade e câncer de mama: uma revisão sistemática da literatura

O objetivo deste estudo foi compreender como o câncer de mama e seus tratamentos afetam a vivência da sexualidade da mulher acometida. Foi realizada uma revisão sistemática qualitativa de artigos científicos, publicados entre 2000 e 2010, disponíveis nas bases de dados PubMed, Web of Science, LILACS e SciELO. Foram obtidos 50 artigos cujos textos foram categorizados segundo análise de conteúdo temática. Foram identificadas seis categorias temáticas: a cirurgia mamária e os demais tratamentos para o câncer de mama; a experiência da mulher acometida; o relacionamento afetivo-sexual; estudos sobre relação entre sexualidade e características específicas do câncer; os profissionais de saúde e a atenção à sexualidade; e propostas para amenizar as consequências negativas dos tratamentos na sexualidade. Há necessidade de novos estudos a respeito dos aspectos culturais da sexualidade, diversidade sexual, relacionamento com o parceiro, formação do profissional de saúde e intervenções em sexualidade no contexto do câncer de mama.

Objectified Body Consciousness, Body Image Discomfort, and Depressive Symptoms Among Breast Cancer Survivors in Taiwan

The literature comparing the effects of breast reconstructive surgery, breast-conserving surgery, and mastectomy on body image and mental health yields conflicting results. Objectified body consciousness may be a factor that influences the psychological well-being of breast cancer survivors. Women with average time of 19 months from breast cancer surgery were approached in outpatient clinics to participate in our study. Using structural equation modeling, we tested and verified a model that included self-reported objectified body consciousness, cancer-related body image discomfort, and depression among 193 breast cancer survivors in Taiwan. Our results provided support for the hypothesized indirect relation of objectified body consciousness with depression through the mediating role of cancer-related body image discomfort. Specifically, women with higher objectified body consciousness levels reported more cancer-related body image discomfort, which in turn was related to greater depression. Additionally, the degree of this mediation relationship across surgery types was different. These findings are significant to clinicians who should be cognizant of the potential role of objectified body consciousness in promoting cancer-related body image discomfort and depression in breast cancer survivors. Encouraging women to clarify their perceptions of their new bodies and providing care combined with psychological counseling after breast cancer surgery are critical.

Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health

Sexual health concerns represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that service providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing patients' sexual health concerns has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on the experiences of 21 breast cancer survivors, this paper explores three ways in which fundamental cultural and structural characteristics of the cancer care system in the USA may prevent breast cancer survivors from addressing their sexual health concerns, including: (1) when patients discussed sexual health with their providers, their providers approached sexuality as primarily physical, while participants experienced complex, multidimensional sexual health concerns; (2) specialisation within cancer care services made it difficult for patients to identify the appropriate provider to address their concerns; and (3) the structure of cancer care literally disconnects patients from the healthcare system at the time when sexual side effects commonly emerged. These data suggest that addressing breast cancer survivors' sexual health concerns requires a multifaceted approach to health systems change.

How often do head and neck cancer patients raise concerns related to intimacy and sexuality in routine follow-up clinics?

Intimacy and sexuality problems are underreported in head and neck cancer patients. The aim of this study was to collate the various prompts available in a routine follow-up clinic through the use of an intimacy screening question and Patient's Concerns Inventory (PCI), and to identify how often these problems were raised by patients and what possible actions took place as a consequence. 177 patients completed the intimacy screening question, PCI and UW-QOLv.4 at follow-up clinics, from October 2008 to January 2011. Case note review identified if intimacy was mentioned in clinic letters and if referral for support was made. On the intimacy screening question, 15 % (26) reported problems of considerable/some concern (24) or selected intimacy/sexuality on the PCI (2). The PCI identified that 9 of the 24 reporting the worst problems wanted the topic discussed in clinic, and clinic letters suggested that 5 of these discussed the issue in clinic with 4 being referred on, 3 to a clinical psychologist and 1 to a clinical nurse specialist. Intimacy problems are underreported in clinic reviews. It is a difficult subject to discuss. It will remain a potential unmet need unless attempts are made to advance the opportunities for patient screening, information leaflets, staff training on how to talk about such sensitive issues and referral for counselling.

Feeling like me again: a grounded theory of the role of breast reconstruction surgery in self-image

The present study aimed to develop a theoretical understanding of the role of breast reconstruction in women's self-image. Semi-structured interviews were conducted with 10 women from breast cancer support groups who had undergone breast reconstruction surgery. A grounded theory methodology was used to explore their experiences. The study generated a model of 'breast cancer, breast reconstruction and self-image', with a core category entitled 'feeling like me again' and two principal categories of 'normal appearance' and 'normal life'. A further two main categories, 'moving on' and 'image of sick person' were generated. The results indicated a role of breast reconstruction in several aspects of self-image including the restoration of pre-surgery persona, which further promoted adjustment.

Qualidade de vida em grupos de mulheres acometidas de câncer de mama

O objetivo deste estudo foi investigar a qualidade de vida de mulheres integrantes de um Grupo de Apoio acometidas de câncer de mama e comparar a qualidade apurada entre as mulheres mastectomizadas que fizeram reconstrução mamária com aquelas que não fizeram além daquelas submetidas à quadrantectomia que não necessitavam da reconstrução com aquelas que não fizeram a reconstrução. Trata-se de estudo transversal quantitativo, cuja coleta de dados se deu por meio da aplicação de questionário de caracterização das entrevistadas e pelo SF-36 da OMS. Participaram 50 mulheres com idade média de 57,2 anos. Os grupos foram comparados entre si - dois a dois - considerando os tipos de cirurgia, por meio do Teste de Mann Whitney, ao nível de 5% de significância. Os resultados apontaram que as mulheres que realizaram a cirurgia de quadrantectomia e não necessitaram de reconstrução são as que possuem os melhores escores médios em todos os domínios e, portanto, têm melhor qualidade de vida, seguido do grupo de mastectomizadas que fizeram reconstrução. O grupo das mastectomizadas que não fizeram a reconstrução tem um nível muito baixo de qualidade de vida, seguido pelo grupo das mulheres que realizaram a quadrantectomia e também não fizeram a reconstrução.

The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis

The purpose of this study was to analyze the available evidence concerning the effects of breast reconstruction (BR) on body image of women with breast cancer. BR is a potential intervention to improve the body image of women with breast cancer. Conflicting research findings about the effects of breast reconstructive surgery on body image compared to breast conservative surgery (BCS) or mastectomy exist. A meta-analysis of studies found in MEDLINE, CINAHL, PsychINFO, PubMed as well as PQDT (dissertation and theses), and other unpublished literature resources from 1970 to 2010 were searched. Comparable studies that examined the difference of body image between breast cancer women receiving mastectomy plus BR and those with BCS were included. A clear definition about the domains of body image including body stigma, body concern, and transparency were identified. Mean effect sizes were calculated. Twelve studies were included in the meta-analysis. Women with BR and BCS were no different on the body concern domain of body image. However, women with BR had a significantly worse score on body stigma domain of body image than women receiving BCS. Women with BR had a better body image score than women with mastectomy. Women who are satisfied with their body shape may still perceive deficiencies because of the stigma of mastectomy and affect on body image. Consistent application of valid and reliable measures of body image specific to breast cancer women is needed.

Body image in recently diagnosed young women with early breast cancer

OBJECTIVE

To assess body image concerns among young women following a breast cancer diagnosis.

METHODS

A total of 419 women with recently diagnosed stage 0-III breast cancer were surveyed following enrollment as part of a prospective cohort study of women age 40 or younger at diagnosis. Body image was assessed using three items from the psycho-social scale of the Cancer Rehabilitation Evaluation System (CARES). CARES scores range from 0 to 4, with higher scores indicative of greater image concerns. Mean CARES scores were calculated and compared between treatment groups using t-tests and analysis of variance. Multiple linear regression models were fit to evaluate the relationship between physical and psychological factors and body image.

RESULTS

Mean time from diagnosis to completion of the baseline survey was 5.2 months. The mean CARES score for all women was 1.28. Mean CARES scores in the mastectomy-only group (1.87) and in the mastectomy with reconstruction group (1.52) were significantly higher (p < 0.0001) compared with the scores in the lumpectomy group (0.85), indicating that radical surgery was associated with more body image concerns. Radiation (p = 0.01), anxiety (p = 0.0001), depression (p < 0.0001), fatigue (p = 0.04), musculoskeletal pain symptoms (p < 0.0001), weight gain (p = 0.01), and weight loss (p = 0.02), in addition to surgery type (p < 0.0001), were all associated with more body image concerns in the multi-variable analysis.

CONCLUSION

This analysis highlights the impact of treatment, along with physical and psychological factors, on body image early in the survivorship period. Our findings provide targets for potential future intervention and may aid young women in the surgical decision-making process.

Challenges in the treatment of younger women with breast cancer

SUMMARY Breast cancer in the younger patient is a perplexing issue for many clinicians because the topic is fraught with so much uncertainty. While most clinicians know that young women unfortunately fare worse after a breast cancer diagnosis, it is not clear how to best improve that outcome. Issues that are unique to young, premenopausal women regarding both local and systemic therapy will be discussed in this article. Additionally, the side effects of surgery, radiation, chemotherapy and hormonal therapy can be particularly damaging to a younger woman’s quality of life. In particular, sexual dysfunction and infertility are common problems that are extremely important to young patients, although many doctors actually avoid these topics because of unfamiliarity with their management. This article aims to shed light on these clinically relevant topics.