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Padmalatha S, Tsai YT, Ku HC, Wu YL, Yu T, Fang SY, Ko NY. Higher Risk of Depression After Total Mastectomy Versus Breast Reconstruction Among Adult Women With Breast Cancer: A Systematic Review and Metaregression. Clin Breast Cancer 2021; 21:e526-e538. [PMID: 33541834 DOI: 10.1016/j.clbc.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
This systematic review with a meta-regression was conducted to determine the risk of depression after mastectomy compared to breast reconstruction among women with breast cancer 1 year after surgery. A literature search was conducted according to PRISMA guidelines using 4 databases: Medline (Ovid), Embase, Cinahl, and the Cochrane Library for the period January 2000 to March 2019. Studies that measured the status of depression within 1 year and immediately after surgery were included. Outcomes related to depression were analyzed by using a pool of event rates and a risk ratio of 95% confidence interval (CI), P value, and a fitting model based on the results of a heterogeneity test of mastectomy and BR. The statistical analysis was conducted using Comprehensive Meta-analysis 3.0 software. Nine studies met the inclusion criteria. There were 865 cases of mastectomy only, with a 22.2% risk of depression (95% CI, 12.4-36.2). In 869 women who underwent BR, the risk of depression was 15.7% (95% CI, 8.8-26.2). The depression risk ratio for mastectomy compared to BR was 1.36 (95% CI, 1.11-1.65). Patients with delayed reconstruction exhibited lower levels of depression (risk ratio 0.96, 95% CI 0.57-1.01). The Beck Depression Inventory (BDI) scale showed high sensitivity, and the Hospital Anxiety Depression Scale (HADS) with a cutoff of > 7 could measure even low to moderate depressive symptoms. One in 4 women with breast cancer had symptoms of depression after mastectomy; both surgeries were associated with depression in women 1 year after surgery. Our results will permit the development of proactive treatment plans before and after surgery to mitigate risk and prevent depression through the use of sensitive depression scales like BDI.
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Affiliation(s)
- Sriyani Padmalatha
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Tseng Tsai
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Chang Ku
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Lin Wu
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan.
| | - Su-Ying Fang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Tyner TE, Lee MA. Satisfaction Outcomes in Women Who "Choose to Go Flat" After Mastectomy: An Integrative Review. ANS Adv Nurs Sci 2021; 44:31-51. [PMID: 32956091 DOI: 10.1097/ans.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A considerable number of women undergoing mastectomies are "choosing to go flat," forgoing reconstruction. This integrative review sought to identify satisfaction outcomes and relevant factors among these women. Using variations of the key word "going flat," a systematic search of 7 databases was conducted. Fifteen articles met the inclusion criteria and were reviewed. Decisional and breast/chest appearance satisfaction in women who did not have reconstruction was mixed when compared with other surgical options. Body image, body mass index, radiation therapy, and access to information/resources affected satisfaction. Nurses are in a pivotal role to address the communication and informational needs of these women to support optimal surgical decision-making processes and improve patient satisfaction and clinical outcomes.
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Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1316. [PMID: 28740762 PMCID: PMC5505823 DOI: 10.1097/gox.0000000000001316] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/07/2017] [Indexed: 01/22/2023]
Abstract
Background: Studies have confirmed that breast reconstruction is beneficial to improve health-related quality of life (HR-QoL) in breast cancer patients. Our aim was to compare 4 different methods of breast reconstruction on patient satisfaction and HR-QoL using both general and specific patient-reported outcome instruments. Methods: Retrospectively, 459 patients who underwent breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, latissimus dorsi flap, lateral thoracodorsal flap, or expander with secondary implant and who had responded to the questionnaires were enrolled. Questionnaire answers, together with demographic and follow-up data, were statistically analyzed and compared between groups. Short-Form 36 Health Survey (SF-36) results were also compared with those from a sample of 930 age-matched women from the Swedish population. Results: There were slight differences in the SF-36 results but no significant differences in Psychological General Well-Being Index and EuroQoL-5 Dimension Questionnaire results between groups. Analysis of Breast-Q showed that the DIEP group had significantly higher score on the scale satisfaction with breast, significantly higher score in satisfaction with outcome than the lateral thoracodorsal flap (P = 0.014) and EXP groups (P = 0.024). There were no significant differences in most of the domains of the HR-QoL instruments. The higher satisfaction with breasts and outcome in the DIEP group is interesting, considering the higher complication rates associated with this reconstruction method. Conclusions: Patients who underwent breast reconstruction with a DIEP flap were more satisfied with their reconstructed breast and outcome than the other 3 groups. Breast reconstruction centers should make DIEP reconstruction widely available to patients after mastectomy.
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Oh D, Flitcroft K, Brennan M, Spillane A. Patterns and outcomes of breast reconstruction in older women – A systematic review of the literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:604-15. [DOI: 10.1016/j.ejso.2016.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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