The Effect on Quality of Life and Body Image of Mastectomy Among Breast Cancer Survivors

Resilience's impact on quality of life and post-traumatic growth in breast cancer patients during treatment

BACKGROUND

This article aims to examine how psychological resilience influences the interplay between quality of life and post-traumatic growth among breast cancer patients receiving follow-up care and treatment in Türkiye.

METHODS

The study involved 119 female individuals diagnosed with breast cancer who visited the Oncology outpatient clinic at a state hospital in Türkiye from January to September 2023. Data were gathered through the administration of a survey form and the utilization of several assessment tools, including the Adult Life Quality Scale in Cancer Survivors (QLACS), the Brief Resilience Scale (BRS), and the Post-traumatic Growth Inventory (PTGI). Data analysis was carried out using SPSS 25 software.

RESULTS

The participants demonstrated an inverse correlation between Post-Traumatic Growth (PTG) and two QLACS sub-dimensions, namely recurrence and family concern. Conversely, a positive association was identified between PTG and the advantages of dealing with cancer. Furthermore, a statistically significant positive association was established between BRS and all QLACS sub-dimensions, except for family concern and appearance. However, it was determined that psychological resilience did not act as a moderator in the relationship between PTG and QLACS.

CONCLUSION

It is important to enhance psychological resilience in women who have survived cancer at all stages of the cancer journey, including the years after treatment, to have a positive impact on post-traumatic growth and quality of life.

Decision-making experiences related to mastectomy: A descriptive qualitative study

AIM

To obtain an in-depth understanding of women's decision-making experiences related to mastectomy.

DESIGN

A descriptive qualitative interview study.

METHODS

Individual semi-structured interviews were conducted face-to-face with 27 Chinese women with breast cancer who underwent mastectomy at two tertiary hospitals in mainland China between September 2020 and December 2021 after obtaining the appropriate ethical approvals. Interviews were conducted in Mandarin. Data were analysed using inductive content analysis.

RESULTS

Mean age of participants was 48 years (range 31-70). Most participants had low education, low monthly family income, had a partner and health insurance, had been diagnosed with early breast cancer, and had not undergone reconstructive surgery. Six categories related to decision-making experiences emerged: (1) Emotions affecting decision-making, (2) Information seeking for decision-making, (3) Beliefs about mastectomy and the breast, (4) Participation in decision-making, (5) People who influence decision-making, and (6) Post-decision reflection. Participants did not mention the role of nurses in their decision-making process for mastectomy.

CONCLUSIONS

This study adds valuable insights into the limited evidence on women's experience with decision-making about mastectomy from a Chinese perspective, which is important given the continuing high prevalence of mastectomy in many regions. Future studies from other countries and ethnic groups are recommended to gain diverse knowledge.

IMPACT

The findings of this study are useful for nurses and other healthcare professionals in the multidisciplinary team to better support women with breast cancer in their decision-making process regarding mastectomy. The findings could inform future interventions to support treatment decision-making and may be relevant to women living in similar socio-medical contexts to those in mainland China.

REPORTING METHOD

The study was reported following the Standards for Reporting Qualitative Research checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The impact of prophylactic mastectomy on sexual well-being: a systematic review

INTRODUCTION

Considering the increasing women's awareness of health promotion and disease prevention programs, mutation carriers are inevitably asked to face important decisions concerning the possibility of undergoing prophylactic mastectomy. Risk-reducing mastectomy (RRM) has become increasingly more common, although it has a significant impact on women's quality of life and sexual well-being.

OBJECTIVES

The systematic review aims to evaluate the impact of RRM on the sexuality of women with breast cancer.

METHODS

According to Cochrane Collaboration guidelines and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, the study quantified the effects of frontline work on the mental health of healthcare workers. This review followed the PRISMA guidelines. Three databases were systematically searched from inception to December 2022. The expression ("sexuality" OR "sexual" OR "sex") AND ("prophylactic mastectomy" OR "risk-reducing mastectomy") was searched in PubMed, Ovid Medline, and Embase. Twenty-two articles published in English until 2022 were selected.

RESULTS

Two studies investigated sexual experience after risk-reducing surgeries as a single outcome, while other studies analyzed the relationship between sexuality and psychosocial outcomes, risk perception, and satisfaction. In all of the included studies, significant findings in sexual dysfunction were found. The most reported problems were related to sexual satisfaction and attractiveness, body image, and loss of femininity. Last, women reported changes in the relationship with their partners.

CONCLUSION

RRM has a major impact on body image that affects sexual functioning and quality of life. These implications must be considered during treatment selection.

An investigation of the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer: a randomized controlled trial

BACKGROUND

Breast cancer is an extremely unpleasant and unbearable experience that can have a profound impact on a person's life. Compared to other types of cancer, breast cancer has a more severe psychological impact on women.

PURPOSE

This study aimed to investigate the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer.

METHOD

A sample of 30 women with breast cancer were randomly divided into intervention and control groups. The research was conducted in the oncology division of Imam Reza Hospital in Kermanshah by the clinical trial method with a two-group pretest-posttest design and a 2 month follow-up. Participants in the intervention group received Mindfulness-integrated cognitive behavior therapy for eight sessions. The intervention was carried out individually in weekly 60 min sessions. While the control group received self-help treatment (through an educational book). A demographic questionnaire, Demoralization Scale (DS-II), Body Image Scale (BIS), and Female Sexual Function Index (FSFI) were used to collect data. For data analysis, means and standard deviations were calculated and repeated measures and the Bonferroni test was conducted using SPSS 26.

RESULTS

The results showed the effectiveness of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function (p < 0.05). Concerning demoralization in the intervention group, the pre-test mean was 16.73 ± 3.33, and it reduced to 11.93 ± 1.49 in the post-test. The body image mean score showed a decreasing trend in the intervention group, from 12.47 ± 1.88 in the pre-test to 8.80 ± 3.21 in the post-test. The mean score for sexual function showed an increasing trend, increasing from 18.06 ± 2.29 in the pre-test to 23.07 ± 0.91 in the post-test. There was no significant difference in the mean score of the post-test compared to the pre-test and follow-up in the control group (p < 0.05).

CONCLUSION

MICBT can be used in conjunction with pharmaceuticals and medical treatments to improve the psychological symptoms of women with breast cancer, according to this study's results. Trial registration (IRCT20160103025817N6). 2022-04-06.

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.

Cross-Cultural Adaptation and Validation of the Korean Version of the Body Image After Mastectomy Scale

OBJECTIVE

This study aimed to evaluate the psychometric properties and validity of the Korean version of the Body Image After Mastectomy Scale (K-BIMS).

METHODS

This validation study was divided into two phases. Phase 1 included the translation of the K-BIMS according to the World Health Organization recommendations, investigation of content validity by five experts, and a pilot study involving 10 participants for the final list of K-BIMS items. The study participants included 156 women who met the inclusion and exclusion criteria to verify the validity-reliability of the K-BIMS. Phase 2 included a validity-reliability analysis of the K-BIMS. This included convergent validity, known-group validity, construct validity assessed by confirmatory factor analysis, and item-total score correlation. We assessed internal consistency using the Cronbach α.

RESULTS

The K-BIMS confirmatory factor analysis demonstrated good fitness of indices and validity including content validity, convergent validity, and known-group validity was satisfactory. Internal consistency reliability was satisfying with a Cronbach α reliability of .89.

CONCLUSIONS

The results revealed that the K-BIMS is a valid and reliable instrument for assessing appearance-based behaviors and beliefs about body image distress among women who underwent reconstructive surgery after mastectomy.

IMPLICATIONS FOR NURSING PRACTICE

To identify individuals who exhibit maladaptive symptoms and are at risk of developing long-term body image problems, the K-BIMS can be used as a point-of-care screening tool. Therefore, the K-BIMS can be used as an early screening tool to proactively offer accessible and affordable solutions.

Impact of autologous breast reconstruction on bra fit

PURPOSE

To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction.

METHODS

We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t-test or Wilcoxon signed-rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction.

RESULTS

Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit.

CONCLUSION

Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.

Preimplantation genetic testing for embryos predisposed to hereditary cancer: Possibilities and challenges

Preimplantation genetic testing (PGT), which was developed as an alternative to prenatal genetic testing, allows couples to avoid pregnancies with abnormal chromosomes and the subsequent termination of the affected fetus. Originally used for early onset monogenic conditions, PGT is now used to prevent various types of inherited cancer conditions based on the development of PGT technology, assisted reproductive techniques (ARTs), and in vitro fertilization (IVF). This review provides insights into the potential benefits and challenges associated with the application of PGT for hereditary cancer and provides an overview of the existing literature on this test, with a particular focus on the current challenges related to laws, ethics, counseling, and technology. Additionally, this review predicts the future potential applications of this method. Although PGT may be utilized to predict and prevent hereditary cancer, each case should be comprehensively evaluated. The motives of couples must be assessed to prevent the misuse of this technique for eugenic purposes, and non-pathogenic phenotypes must be carefully evaluated. Pathological cases that require this technology should also be carefully considered based on legal and ethical reasoning. PGT may be the preferred treatment for hereditary cancer cases; however, such cases require careful case-by-case evaluations. Therefore, this study concludes that multidisciplinary counseling and support for patients and their families are essential to ensure that PGT is a viable option that meets all legal and ethical concerns.

The Effectiveness of an Upper Limb Rehabilitation Program on Quality of Life in Breast Cancer Patients after Mastectomy: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of an upper limb rehabilitation program on the quality of life in patients who had been first diagnosed breast cancer and subsequently underwent mastectomy.

DATA SOURCES

This randomized controlled trial enrolled 48 breast cancer patients who underwent mastectomy at a medical center in Taiwan. The patients were randomly assigned to either the intervention group (n = 24) or control group (n = 24). The patients in the intervention group participated in a 12-week upper limb rehabilitation program involving face-to-face upper limb rehabilitation education and once-a month monitoring of their upper extremity activity. The control group received standard nursing care. Quality of life was assessed through EORTC QLQ-C30 and QLQ-BR 23 questionnaires at baseline and weeks 4, 8, and 12 after enrollment.

RESULTS

Both the intervention and control groups had significantly improved their levels of functioning, symptoms, and quality of life from baseline to week 12 after enrollment. The intervention group showed greater improvements in functioning and symptom levels after the intervention compared to the control group; however, no statistically significant differences were found. Additionally, the levels of global health status/quality of life in both groups gradually increased from baseline to week 12 CONCLUSION: An upper limb rehabilitation program is effective in improving the functioning and symptoms of breast cancer patients who have undergone mastectomy.

IMPLICATIONS FOR NURSING PRACTICE

Patients are encouraged to undergo upper limb rehabilitation in order to improve their functioning, symptoms and quality of life.

Targeting breast cancer stem cells through retinoids: A new hope for treatment

Breast cancer is a complex and diverse disease accounting for nearly 30% of all cancers diagnosed in females. But unfortunately, patients develop resistance to the existing chemotherapeutic regimen, resulting in approximately 90% treatment failure. With over half a million deaths annually, it is imperative to explore new therapeutic approaches to combat the disease. Within a breast tumor, a small sub-population of heterogeneous cells, with a unique ability of self-renew and differentiation and responsible for tumor formation, initiation, and recurrence are referred to as breast cancer stem cells (BCSCs). These BCSCs have been identified as one of the main contributors to chemoresistance in breast cancer, making them an attractive target for developing novel therapeutic strategies. These cells exhibit surface biomarkers such as CD44+, CD24-/LOW, ALDH, CD133, and CD49f phenotypes. Higher expression of CD44+ and ALDH activity has been associated with the formation of tumors in various cancers. Moreover, the abnormal regulation of signaling pathways, including Hedgehog, Notch, β-catenin, JAK/STAT, and P13K/AKT/mTOR, leads to the formation of cancer stem cells, resulting in the development of tumors. The growing drug resistance in BC is a significant challenge, highlighting the need for new therapeutic strategies to combat this dreadful disease. Retinoids, a large group of synthetic derivatives of vitamin A, have been studied as chemopreventive agents in clinical trials and have been shown to regulate various crucial biological functions including vision, development, inflammation, and metabolism. On a cellular level, the retinoid activity has been well characterized and translated and is known to induce differentiation and apoptosis, which play important roles in the outcome of the transformation of tissues into malignant. Retinoids have been investigated extensively for their use in the treatment and prevention of cancer due to their high receptor-binding affinity to directly modulate gene expression programs. Therefore, in this study, we aim to summarize the current understanding of BCSCs, their biomarkers, and the associated signaling pathways. Retinoids, such as Adapalene, a third-generation retinoid, have shown promising anti-cancer potential and may serve as therapeutic agents to target BCSCs.

"My body, my choice": A qualitative study of women's mastectomy with flat closure experiences

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

Breast Conserving Surgery is Better for Sexual Satisfaction Compared to a Modified Radical Mastectomy for Breast Cancer

PURPOSE

This study aimed to determine the difference between the level of sexual satisfaction in breast cancer patients with Modified Radical Mastectomy (MRM) and Breast Conserving Surgery (BCS).

METHODS

This study used a cross-sectional study using a validated Female Sexual Function Index questionnaire. This study was conducted from 2020 until 2021. Data were collected and analyzed using the chi-square test for bivariate variables and logistic regression for multivariate variables.

RESULTS

Patients with BCS were more satisfied with their sexual activity than patients undergoing modified radical mastectomy (p = 0.0001, OR 6.25, CI = 2.78 - 14.01). Other factors having effect on sexual satisfactions were: age that showed a statistically effect on sexual satisfaction (patients <55 years were more satisfied than patients ≥55 years ( p = 0.004, OR = 3.23, CI 1.44 - 7.22), the period after operation (<5 years vs >5 years) showed a statistically significant difference in sexual satisfaction ( p = 0.087, OR=0.53, CI = 0.25-1.10), Having chemotherapy treatment showed statistically significant risk for sexual satisfaction (p = 0.003, OR=7.39, CI= 1.62-33.83). Factors having no statistically significant effect on sexual satisfactions were: Radiotherapy treatment (p = 0.133, OR=1.75 and CI = 0.84 -3.64), length of marriage as defined with <10 years and > 10 years (p = 0.616, OR=1.39 and CI = 0.38-5.09), marital status (p = 0.082, OR =0.39, CI=0,13 - 1.16), educational status (p = 0.778, OR = 1.18, CI = 0.37 - 3.75), and work at home vs outside home (p = 0.117, OR=1.8, and CI = 0.86 - 3.78).

CONCLUSION

BCS as surgical therapy option is the most dominant factor related to sexual satisfaction followed by age group, and chemotherapy group.

Impact of Autologous Breast Reconstruction on Bra Fit

Purpose

To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction.

Methods

We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t test or Wilcoxon signed rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction.

Results

Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit.

Conclusion

Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.

Body change stress, sexual function, and marital intimacy in korean patients with breast cancer receiving adjuvant chemotherapy: A cross-sectional study

Objective

A crucial factor influencing the quality of life of patients with breast cancer is marital intimacy, which, along with emotional support, helps them overcome difficult treatments. This study aimed to elucidate and confirm the effects of body change stress and sexual function in marital intimacy.

Methods

We conducted a cross-sectional survey on 190 patients with breast cancer. They completed the breast-impact of treatment scale, female sexual function index, and revised dyadic adjustment scale.

Results

The patients' average age was 46.27 (6.84), and the age distribution ranged from 25 to 59 years. These variables showed statistically significant differences according to the chemotherapy period (P ​< ​0.05) and type of surgery (P ​< ​0.05). Body change stress negatively correlated with sexual function (r ​= ​-0.523, P ​< ​0.001) and marital intimacy (r ​= ​-0.545, P ​< ​0.001). Sexual function positively correlated with marital intimacy (r ​= ​0.363, P ​< ​0.001). Marital intimacy was affected by the changes in body stress (β ​= ​-0.473, P ​< ​0.001). Sexual function did not affect marital intimacy (β ​= ​0.084, P ​= ​0.289).

Conclusions

Changes in body stress and chemotherapy treatment should be considered in patients with breast cancer for better marital intimacy. Intervention strategies that consider the characteristics discussed could improve marital intimacy for patients with breast cancer.

Preoperative Assessment of the Breast Reconstruction Patient

Through a multidisciplinary approach, as well as, a nuanced appreciation of patient goals and setting appropriate expectations, breast reconstruction can significantly improve the quality of life following mastectomy. A thorough review of the patient medical and surgical history in addition to oncologic treatments will facilitate discussion and recommendations for an individualized shared decision-making reconstructive process. Alloplastic reconstruction, although a highly popular modality, has important limitations. On the contrary, autologous reconstruction is more flexible but requires more thorough consideration.

Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors

Body image (BI) and self-esteem (SE) are two fundamental aspects in the evolution of breast cancer (BC), mainly due to surgery, treatment, and the patient's conception of BI. A dissatisfaction with BI and low SE decreases the subject's quality of life and increases the risk of recurrence and mortality by BC. The aim of this study is to find out if there is any degree of association between the sociodemographic data of the sample and their BI and SE. A cross-sectional, descriptive study was conducted with 198 women diagnosed with BC, aged 30-80 years, in Mexico. Women's BI and SE were assessed using two questionnaires, Hopwood Body Image Scale (S-BIS) and Rosenberg Self-Esteem Scale (RSES). The results show significant differences in several items when the variable sense of humor is taken into account, indicating that women with a sense of humor report higher satisfaction with their BI and higher SE. The age also indicates a significantly better BI in women over 50 years of age, as well as the education level variable, where those women who had studied up to secondary reported higher satisfaction with their BI; the family history shows that those women without a family history report better SE. All these data are supported by stepwise regression, which shows that educational level and sense of humor are predictors of BI, and family history along with breast reconstruction and sense of humor are predictors as of SE. In conclusion, it is important to take into account the characteristics of women with BC, particularly age and sense of humor, in order to reduce the impact of the disease on their BI and SE with the help of a multidisciplinary team.

Effect of Psychosocial, Behavioral, and Disease Characteristics on Health-Related Quality of Life (HRQoL) After Breast Cancer Surgery: A Cross-Sectional Study of a Regional Australian Population

BACKGROUND

 Increasing long-term breast cancer survivorship has highlighted the importance of patient-reported outcomes such as health-related quality of life (HRQoL) in addition to traditional outcomes that were used to define successful operative management. This study aimed to describe HRQoL in patients who underwent breast cancer resection in a regional Australian setting and identify the psychosocial, demographic, and operative characteristics associated with poor HRQoL.

METHODS

 Consecutive patients who underwent breast cancer resection between 2015 and 2022 were included. Patients were asked to complete a survey instrument that included validated measures of HRQoL, emotional distress, fear of cancer recurrence (FCR), and social support. Demographic, disease, and operative data were collected from the medical record of the respondents.

RESULTS

 Forty-six patients completed the survey (100% female, mean age = 62.68 years). Most HRQoL domains were significantly lower than an Australian reference population. HRQoL was more strongly associated with psychosocial factors (emotional distress, FCR, and social support) but was also associated with socioeconomic status, stage of cancer at presentation, and surgical complications. HRQoL was not related to breast conservation, management of the Axilla, or time since operation.

CONCLUSION

 Long-term changes in HRQoL should be considered during the management and surveillance of breast cancer patients in regional Australia.

Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image

PURPOSE

This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship.

METHODS

We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure.

RESULTS

SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62).

CONCLUSIONS

Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.

Deep Inferior Epigastric Perforator Flap for Immediate Breast Reconstruction following Mastectomy in Breast Cancer Patients: An Initial Experience in Vietnam

Background

Breast reconstruction in breast cancer patients is an optional surgery that improves the quality of life while preserving the efficacy of chemotherapy and radiotherapy. Deep inferior epigastric perforator (DIEP) flap is a new but reliable and safe technique for autologous breast reconstruction. After mastectomy, immediate reconstruction is the preferred method because of its aesthetic result and convenience. This study is aimed at summarizing our experience in DIEP flap for immediate breast reconstruction.

Methods

A prospective study was performed on 30 breast cancer patients who underwent intermediate breast reconstruction for DIEP flap after mastectomy from June 2019 to June 2021 in Hanoi Medical University Hospital. Clinicopathology characteristics, tumor stage, treatment, and complications were evaluated.

Result

The mean age of patients was 44.9 (range: 29-73 years). 86.7% of patients were in stages I and II. Five patients (16.7%) received neoadjuvant chemotherapy. 20 patients (66.7%) underwent nipple-sparing mastectomy (NSM) procedures. The mean operating time was 341 minutes. The mean time to receive chemotherapy was 34.68 days. The mean number of perforators was 1.30. The overall flap success rate was 90%. Twelve patients (40%) experienced complications. Four patients (13.3%) returned to the operating room due to venous congestions. Two patients (6.67%) had complete flap loss. Other complication: fat necrosis (6.7%), seroma (13.3%), partial flap loss (3.3%), abdominal wound dehiscence (6.7%), pneumonia (3.3%), and pulmonary embolism (6.7%). After one-month postoperation, 88.9% of patients were satisfied with their breasts, and 74.07% were satisfied with the operation.

Conclusion

DIEP flap is a new but reliable and safe technique for autologous breast reconstruction. Though patients opting for breast reconstruction still have a low risk of complication and reconstruction failure, this procedure should be used more frequently in appropriate patients to improve their quality of life.

Investigation of the relationship between perceived social support and body image in women with breast cancer

Background

Patients with breast cancer have more body image disorders than healthy individuals. The present study aimed to determine the relationship between perceived social support and body image in women with breast cancer. This descriptive-analytical study was performed on 192 women with breast cancer undergoing mastectomy or tumor resection with breast preservation referred to Golestan Hospital in Ahvaz from February 2016 to May 2017. Data collection tools included Demographic Information, Perceived Social Support, and Multidimensional Body-Self Relationship Questionnaires (MBSRQ). Data analysis was performed using SPSS 22 and Pearson correlation coefficient and multivariate linear regression. A p value less than 0.05 was considered significant.

Results

The Pearson correlation test showed a positive and significant relationship between perceived social support from family, friends, and leading people and body image in mastectomy (r 0.81) and tumor resection groups with breast preservation (r 0.78) (p < 0.001).

Conclusion

The results showed a direct relationship between perceived social support and body image in women with breast cancer. Accordingly, by educating patients and their families and medical staff about the importance of perceived social support, it is possible to help improve the dimensions of social support in these patients and improve the body image of these patients.

Systematic review on factors associated with self-perceived burden among cancer patients

INTRODUCTION

Cancer is the leading cause of death in the world. There was a high prevalence of high self-perceived burden (SPB) among cancer patients and this could bring adverse consequences to the physical and mental health of cancer patients, which can lead to suicide if not treated well. This review aims to determine the prevalence of SPB among cancer patients and its risk factors.

METHODS

Published journals before September 2021, from five databases (PubMed, ScienceDirect, Springer, Cochrane, and CNKI) were retrieved according to the keywords. The keywords used included cancer patients, terminally ill patients, cancer, SPB, self-perceived burden, self-burden, self-perceived, factor, predictor, associated factor, determinants, risk factor, prognostic factor, covariate, independent variable, and variable. The quality of the inclusion and exclusion criteria was independently reviewed by three researchers.

RESULTS

Out of 12,712 articles, there are 22 studies met the eligibility criteria. The prevalence of SPB among cancer patients ranged from 73.2 to 100% in Malaysia, China, and Canada. Most of them had moderate SPB. Out of the reported factors, age, gender, marital status, ethnicity, residence, educational level, occupational status, family income, primary caregiver, payment methods, disease-related factors, psychological factors, and physical factors were mostly reported across the studies.

CONCLUSIONS

In conclusion, SPB prevalence is high in cancer patients. Therefore, hospitals, non-governmental organizations, relevant policymakers, and communities can provide special programs for high-risk groups to provide psychological guidance or design corresponding interventions to reduce the SPB level of patients and improve the quality of life.

Oncological outcome of single-port insufflation endoscopic nipple-sparing mastectomy versus open mastectomy in early breast cancer patients: a study protocol for a randomised controlled trial

INTRODUCTION

Breast cancer is the most prevalent cancer and the leading cause of cancer-related death in women. Conventional open mastectomy (C-OM) is one of the most common procedures for breast cancer, which involves the removal of the nipple-areola complex and a large proportion of the breast skin, leading to poor cosmetic effect and restriction of upper extremity function. Single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) could conceal the incision along the wrinkles in the axilla, preserve all the breast skin and nipple-areola complex and provide a better cosmetic outcome and quality of life. This trial aims to investigate the oncological safety between SIE-NSM and C-OM in early breast cancer patients.

METHODS AND ANALYSIS

This is a single centre, non-blinded, randomised controlled trial (RCT) and will be conducted at Beijing Friendship Hospital. Patients will be enrolled in the inpatient ward. Breast surgeons will notify patients who meet the inclusion and exclusion criteria with the instruction of this RCT. Patients will be randomly assigned to C-OM or SIE-NSM with a 3:1 allocation as per a computer-generated randomisation schedule. Patients will be followed-up for 12 months for analysing surgical outcomes. The primary outcome is the local recurrence rate at a 12-month follow-up. The secondary outcome is the distant metastasis rate, cosmetic satisfaction score and psychosocial well-being score after a 12-month follow-up. To ensure the accuracy of the cosmetic satisfaction score and psychosocial well-being score, the standard scale, Breast-Q score, will be applied.

ETHICS AND DISSEMINATION

This study will be conducted according to the medical ethics committee of the Beijing Friendship Hospital and according to the principles of the Declaration of Helsinki. All patients will receive clear instruction of their disease and treatment plan. Informed consent will be obtained from all patients when they agree to comply with our research plan. The results will be disseminated at academic presentations and publications in peer-reviewed journals. The raw data will be confidentially stored in our electronic data capture database. Data will not be shared unless an appropriate data request is submitted after the trial completion and peer-review journal publication.

TRIAL REGISTRATION NUMBER

NCT04461847.

A national analysis of outpatient mastectomy and breast reconstruction trends from 2013 through 2019

BACKGROUND

Traditionally, patients with breast reconstruction (BR) were hospitalized at least one day postoperatively. However, new trends suggest that outpatient surgery is a viable and safe alternative. This study aims to assess trends among patients with breast cancer who underwent outpatient mastectomy alone, with immediate BR (IBR) or delayed BR (DBR).

METHODS

A retrospective analysis of the 2013-2019 ACS NSQIP® database was conducted. All women who underwent outpatient mastectomy were included in this study. The cohort was divided as follows: (1) mastectomy without BR, (2) IBR, and (3) DBR. A Cochran-Armitage test and adjusted multivariable logistic regression models were performed to evaluate linear trends over time within groups, and overall and pairwise comparisons between groups across the years, respectively.

RESULTS

A total of 84,954 women were included in this study. Overall, 54.9%, 16.2%, and 28.9% underwent mastectomy without BR, IBR, and DBR, respectively. From the BR groups, the majority had implant placement. A significant difference in incidence trends between the three groups was evidenced over time (p<0.001). The greatest increase was evidenced in the IBR group and the lowest in the mastectomy without BR group.

CONCLUSION

In this cohort of patients, a significant difference in linear trends was evidenced over time within and between the three groups. Our results suggest that outpatient IBR procedures are increasing in a greater proportion compared to other surgical approaches. Further studies are required to better characterize this population and comprehend the decision-making process toward a surgical procedure within each of the three groups.

Prospective Longitudinal Patient-Reported Satisfaction and Health-Related Quality of Life following DIEP Flap Breast Reconstruction: Effects of Reconstruction Timing

BACKGROUND

Without reconstruction, mastectomy alone can produce significant detrimental effects on health-related quality of life. The magnitude of quality-of-life benefits following breast reconstruction may be unique based on timing of reconstruction. Facilitated by the BREAST-Q questionnaire, characterization of how reconstruction timing differentially affects patient-reported quality of life is essential for improved evidence-based clinical practice.

METHODS

Consecutive DIEP flap breast reconstruction patients prospectively completed BREAST-Q questionnaires preoperatively and at two different time intervals postoperatively. The first (postoperative time point A) and second (postoperative time point B) postoperative questionnaires were completed 1 month postoperatively and following breast revision/symmetry procedures, respectively. Postoperative flap and donor-site complications were recorded prospectively. Stratified by timing (immediate versus delayed) of reconstruction, preoperative clinical data, operative morbidity, and BREAST-Q scores were compared at all time points.

RESULTS

Between July of 2012 and August of 2016, 73 patients underwent 130 DIEP flap breast reconstructions. Collectively, breast satisfaction, psychosocial well-being, and sexual well-being scores significantly (p < 0.001) increased postoperatively versus baseline. Chest and abdominal physical well-being scores returned to baseline levels by postoperative time point B. Preoperatively, patients undergoing delayed breast reconstruction reported significantly (p < 0.05) lower breast satisfaction, psychosocial well-being, and sexual well-being scores compared to immediate reconstruction patients. Postoperatively, delayed and immediate reconstruction patients reported similar quality-of-life scores. Outcome satisfaction and flap and donor-site morbidity were similar between groups irrespective of timing of reconstruction.

CONCLUSIONS

In this prospective study, patient-reported outcomes demonstrate significant improvements in breast satisfaction, psychosocial well-being, and sexual well-being among patients following DIEP flap reconstruction. Moreover, preoperative differences in quality-of-life scores among delayed/immediate reconstruction patients were eliminated postoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Inaugural roundtable on breast reconstruction practice in Australia: background, process and recommendations

Recommendations from the inaugural roundtable on breast reconstruction held on 9 October 2019 in Queensland, Australia, for improved decision-making and increased funding to support wider, timely access to breast reconstruction.

Self-Management Support with Yoga on Psychological Health and Quality of Life for Breast Cancer Survivors

The purpose of this study was to identify whether the improvement of self-management support (SMS) combined with yoga can improve anxiety, depression, stress, and quality of life in female breast cancer survivors. The SMS combined with yoga group and control group (yoga only) were comprised of 21 and 20 participants, respectively. The SMS with yoga and yoga programs were provided to each group for 8 weeks. Data obtained from self-report questionnaires included details of anxiety, depression, stress, and quality of life. The levels of anxiety, depression, and stress significantly decreased in both the SMS with yoga and control groups (p < 0.05). Moreover, the quality of life improved significantly in the SMS with yoga group (p < 0.001). Among the five quality-of-life domains (physical, social/family, emotional and functional well-being, and breast cancer subscale), social/family well-being in the SMS with yoga group was significantly higher than that in the yoga-only group (p = 0.011). Conclusions: The results show that yoga is a beneficial activity for the psychological health of breast cancer survivors. Our findings suggest that SMS strategies can improve quality of life.

Body image and quality of life in women with breast cancer: Appreciating the body and its functionality

Women with breast cancer often experience major physical changes, which can impact their body image and Quality of Life (QoL). Traditional assessments of body image implemented within breast cancer research focus solely on body dissatisfaction. This study explored the association between both positive and negative body image and QoL. Australian women (N = 123) within 5-years of a breast cancer diagnosis were invited to complete a web-based questionnaire including measures of body appreciation and functionality appreciation, cancer-specific measures of body dissatisfaction and QoL, and demographic, health and treatment/illness questions. All body image measures were significantly associated with QoL (p < .01). However, when body image variables were entered simultaneously as predictors of QoL (adjusting for comorbidity, treatment and employment), only body dissatisfaction was significantly associated with QoL (p < .001). Further analyses indicated this was due to shared variance in QoL between body and functionality appreciation, suggesting they assess highly related constructs within this population. Results indicate positive and negative components of body image are relevant to QoL within breast cancer populations; though, body dissatisfaction remained the strongest predictor of QoL indicating its pervasiveness. Future research should explore the development and use of breast cancer-specific measures of positive body image.

Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

BACKGROUND

Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women.

METHODS

Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010-2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage.

RESULTS

From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups.

CONCLUSION

This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.

The effects of the quality nursing mode intervention on the psychological moods, postoperative complications, and nursing satisfaction of breast cancer surgery patients

OBJECTIVE

To evaluate the influence of high-quality care on the psychological well-being, the postoperative complications, and patient satisfaction following a radical mastectomy.

METHODS

One hundred and eighteen breast cancer patients who underwent radical mastectomies from February, 2017 to May, 2019 in the Cancer Hospital of China Medical University were enrolled. Among them, 56 patients treated with regular care were included in the regular group, while the other 62 patients who underwent high-quality care were included in the high-quality group. The postoperative recoveries and complications were compared between the two groups. The visual analogue scale (VAS), the disabilities of the arm, shoulder and hand (DASH) questionnaire, the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the quality of life (QOL) assessment scale, and a patient satisfaction questionnaire were used to evaluate the degrees of pain, the upper limb recovery, the negative emotions, the QOL, the patient satisfaction and the two-year survival rate, respectively.

RESULTS

The ambulation times, the regression times of upper limb swelling, and the hospital stays in the high-quality group were remarkably shorter than they were in the regular group (P<0.05). The postoperative complications were less frequent in the high-quality group (P<0.05). The VAS scores in the high-quality group were lower than they were in the regular group at 1, 3, and 5 days after surgery, and the DASH scores in the high-quality group were lower at 1 month after discharge (P<0.05). The high-quality group showed lower SAS and SDS scores and higher QOL and patient satisfaction than the regular group (all P<0.05). There was no difference in the two-year survival rates between the two groups after the intervention (P>0.05).

CONCLUSION

High-quality care following a radical mastectomy contributes to postoperative recovery, the relief of negative emotions, the reduction of complications, as well as the enhancement of QOL and patient satisfaction, so it is worthy of clinical promotion.

Patient Perceptions and Determinants of Choice for Breast Reconstruction after Mastectomy among Saudi Patients

Background:

Undergoing mastectomy is often associated with a negative impact on the mental well-being of patients. Patients who undergo postmastectomy breast reconstruction (BR) have a better self-image and higher self-esteem. Many patients with breast cancer (BC) are unaware of the availability of BR options. This study aimed to assess BC patient perceptions and identify the determinants of patient choices to undergo BR after mastectomy.

Methods:

This study was conducted between May 10, 2019 and February 29, 2020 via an interview-based questionnaire, among BC patients at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. Ethical approval was obtained from the research ethics committee before the data collection.

Results:

Altogether, 400 patients (an overall 82% response rate) were included, of whom 155 (38.75%) were group 1 (willing to undergo BR). The mean age for group 1 was 46.04 ± 8.79, which was younger than for group 2 (unwilling to undergo BR) (P < 0.001). Furthermore, 117 (75.5%) of group 1 had no history of any chronic illness compared with 145 (59.2%) of group 2 (P < 0.001). Group 1 had more knowledge about BR (69.7%, P < 0.001), and the main reason to undergo BR was to regain femininity (26.8%). The remaining patients (31.3%) were unwilling to undergo BR in order to avoid additional surgery.

Conclusions:

The lack of knowledge and misconception about BR is one factor preventing BC patients from undergoing BR. Spreading awareness and providing accurate information regarding the procedure will allow women with BC to overcome postmastectomy fear.

The effect of a group cognitive behavioral therapy on the quality of life and emotional disturbance of women with breast cancer

PURPOSE

While the rate of survival has increased in the past decade, the diagnosis of breast cancer is an extremely stressful experience for patients and it is associated with the manifestation of several psychological problems. To examine the effect of a group cognitive behavioral therapy (CBT) on the quality of life and emotional disturbance of women with breast cancer.

METHODS

The study was a randomized controlled clinical trial. Samples were 48 women who had been diagnosed with breast cancer and had undergone mastectomy and chemotherapy. Study variables were measured before and after the intervention and 1 month after the end of the intervention as a follow-up. Controls received nothing and were just followed-up. Repeated measure ANOVAs were used to compare the effectiveness of the intervention on the study variables.

RESULTS

The results of 32 women were analyzed. The increase in quality of life scores was significantly higher in the intervention group compared to the control group (P < 0.05). There were also significantly lower changes in the depression, anxiety, and stress scores of the intervention group (P < 0.05). However, the changes in the score of death anxiety were not significantly lower in the intervention group in comparison to controls (P > 0.05).

CONCLUSION

Group cognitive behavioral therapy was effective in the improvement of quality of life and decreases some aspects of emotional disturbance. Findings of this study suggest that women with breast cancer can benefit from group CBT. Yet, some aspects of the mental health of these women may need more attention and individualized methods.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: IRCT20100911004728N4.

The impact of mastectomy on Iranian women sexuality and body image: a systematic review of qualitative studies

PURPOSE

Mastectomy in women is perceived as losing feminine identity and reducing sexual attraction. The aim of this review is to explore the perception and impacts of mastectomy on Iranian women with breast cancer on their sexuality and body image.

METHODS

The review used a systematic literature search that followed the guidelines of the Joanna Briggs Institute (JBI). The data sources PubMed, Scopus, Web of Science, Google Scholar, SID, ProQuest, MEDLINE, and CINAHL (via the EBSCOhost) were systematically searched. Quality appraisal, data extraction, and findings from the included studies were pooled using meta-aggregation with the Qualitative Assessment and Review Instrument (JBI-QARI).

RESULTS

Eight studies involving 163 women aged from 31 to 65 years, who had mastectomy, were included. A total of 31 findings were extracted and were aggregated into 4 categories and then further grouped into two synthesized findings: (1) fear of losing spouse's sexual monopoly and (2) overcoming the challenges of losing femininity.

CONCLUSIONS

This review found even in Muslim countries such as Iran women's breasts are perceived as sexually attractive, and changes in body shape can lead to subsequent challenges in marital relationships.

The impact of mastectomy on body image and sexuality in women with breast cancer: a systematic review

Objective: The study aims to evaluate the impact of mastectomy on body image and sexuality of women with breast cancer, as well as to provide a general understanding of their quality of life. Method: This review followed the PRISMA guidelines. The expression “Mastectomy AND (sexuality OR “body image”)” was searched in Lilacs, Scielo, Pubmed and Scopus databases. Articles published in English, Portuguese and Spanish between 2010 and 2020 were selected. The text analysis was carried out by peers. Results: 69.3% (43) of the studies presented mastectomy as a technique that worsens body image, sexual functioning and quality of life of women. Less radical procedures, such as breast-conserving surgery, showed lower impact on these indicators. Breast reconstruction is an alternative to mitigate breast surgery impacts. Conclusion: Mastectomy caused the major impacts on body image, sexual functioning and quality of life. These implications need to be considered during therapeutic choice.

Empowered Choices: African-American Women's Breast Reconstruction Decisions

Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.

Body Cathexis among Stroke Survivors: A Cross-Sectional Study

Background  Stroke results in functional dependence and poor quality of life. Body cathexis is a measure of one’s perceived body image. Stroke survivors often experience stress, anxiety, and disturbances in body image.

Objectives  The objective of the study was to explore the body cathexis of stroke survivors.

Materials and Methods  The cross-sectional survey was conducted at two rural community settings of Kozhikode district, Kerala. Using a purposive sampling, 151 stroke survivors were recruited.

Results  The mean age of the participants was 64.58 years. About 53.6% participants were males and majority of the participants had ischemic stroke (76.2%). About one-third of participants had moderately severe disability. Among the participants, the body cathexis scale (BCS) ranged from 176 to 202. The overall mean (standard deviation) BCS score was 190.09 (5.04). Satisfaction or dissatisfaction toward each body part was analyzed and found that significant areas of dissatisfaction were energy level (98%), wrist (88.1%), elimination (86.1%), fingers (76.2%), and arms (73.5%). The BCS scores compared with the sides of lesion, gender differences, and duration of stroke showed no significant differences in the mean (p>0.05).

Conclusions  Stroke survivors are found to experience disturbances in body image. Low energy level, poor functioning of upper extremities, and disturbed elimination patterns add primarily to body image disturbances. Body cathexis does not differ with side of lesion, gender differences, and duration of stroke.

Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience

Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.

Prospective Evaluation of Psychological Healing in Adults Who Underwent Otoplasty for Prominent Ear

BACKGROUND

Otoplasty is performed to heal the psychological discomfort caused by the appearance of prominent ear by bringing the ear to its anatomical position. However, there have been few studies with limited numbers of patients that have prospectively evaluated psychosocial recovery following otoplasty in adults. The purpose of this prospective study was to evaluate the versatile psychological recovery that can be achieved in adults following otoplasty.

METHODS

In this prospective cohort study, a single-group, pretest-posttest model was used as the experimental research model. Patient satisfaction status was measured, and the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory I-II (STAI I-II), Rosenberg Self-Esteem (RSES), and Body Cathexis Scale (BCS) tests were performed on patients before and after surgery.

RESULTS

A total of 66 patients with a mean age of 20.7 ± 3.1 years, 66.7% of whom were women, were included in the study. While 97% of the patients were satisfied with the results of the operation, 3% were undecided. The mean values of the BDI, STAI-I, STAI-II, and BCS before and after surgery were 11.4 ± 5.7, 40.9 ± 6.7, 43 ± 9.4, 74.2 ± 20.5, and 8.5 ± 5.5, 38.6 ± 7.4, 39.5 ± 9.2, 63.5 ± 17.6, respectively. While the proportion of patients with a high RSES score before surgery was 42.42%, the proportion after surgery was 96.96%. The differences in the mean scores of all tests before and after surgery were also statistically significant (p < 0.05).

CONCLUSION

Our study demonstrated that otoplasty made positive contributions to body perception, self-esteem, anxiety, and depression in adults. Otoplasty is as beneficial in adults as it is in pediatric patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Augmented reality mastectomy surgical planning prototype using the HoloLens template for healthcare technology letters

In breast reconstruction following a single mastectomy, the surgeon needs to choose between tens of available implants to find the one that can reproduce the symmetry of the patient's breasts. However, due to the lack of measurement tools this decision is made purely visually, which means the surgeon has to order multiple implants to confirm the size for every single patient. In this Letter, the authors present an augmented reality application, which enables surgeons to see the shape of the implants, as 3D holograms on the patient's body. They custom developed a two-chamber implant that can gain different shapes and be used to test the system. Furthermore, the system was tested in a user study with 13 subjects. The study showed that subjects were able to do a comparison between real and holographic implants and come to a decision about which should be used. This method can be quicker than the traditional way and eliminates sizer implants from the process. Further advantages of the method include the use of a more accurate, user-friendly device, which is easily extendable as new implants that are on the market can be easily added to the system dataset.

Sexuality, depression and body image after breast reconstruction

OBJECTIVES

To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression.

METHODS

This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively.

RESULTS

The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics.

CONCLUSION

Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.