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Shekhar N, Jaiswal R, Joseph L, Jain S, Jain S, Kr A, Yashas N, Fernandes A, G C, S V, Reddy T, Reddy L, Kumar R. An Overview of Psychological Analysis of Breast Cancer Patients undergoing Modified Radical Mastectomy and Breast Conservation Surgery and its impact on Objectified Body Consciousness at a Tertiary Care Cancer Centre in South India. Clin Breast Cancer 2023; 23:e394-e400. [PMID: 37400311 DOI: 10.1016/j.clbc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women's mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types. MATERIALS AND METHODS This retrospective analysis of prospectively maintained data included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Modified Radical Mastectomy at tertiary care Cancer Centre, between the years 2020 to 2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t-tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively. RESULTS Out of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Modified radical mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22 ± 15.44) for all patients when compared preoperatively(72.72 ± 11.38) and postoperatively(60.15 ± 17.58). This change was higher in the Modified Radical Mastectomy group(29.38 ± 11.53). Also, statistically significant rise in scores was seen with increasing age. CONCLUSION We could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a Modified Radical Mastectomy, had more psychological apprehension with the body image postsurgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest.
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Affiliation(s)
- Neha Shekhar
- Department of Psychology, Vidyashilp Academy, Bengaluru, Karnataka, India
| | - Richa Jaiswal
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India.
| | - Leesha Joseph
- Department of Psychology, Vidyashilp Academy, Bengaluru, Karnataka, India
| | - Shraddha Jain
- Department of We Can Team, Manipal Hospitals Bengaluru, Karnataka, India
| | - Salil Jain
- Department of We Can Team, Manipal Hospitals Bengaluru, Karnataka, India
| | - Ashwin Kr
- Department of Surgical Oncology, Aster CMI Hospitals, Bangalore, Karnataka, India
| | - Nitin Yashas
- Department of Medical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Aaron Fernandes
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Chandana G
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Vanitha S
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Trupthi Reddy
- Department of Surgery, Manipal University, Tiger Circle Road, Manipal, Karnataka, India
| | - Lavanya Reddy
- Department of Surgery, St. Johns College Hospital, Bangalore, Karnataka, India
| | - Rohit Kumar
- Department of Surgical Oncology, Aster CMI Hospitals, Bangalore, Karnataka, India
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McKevitt E, Saleeb M, Liu G, Warburton R, Pao JS, Dingee C, Bazzarelli A, Tang K, Crump T, Sutherland JM. Differences in Preoperative Health-Related Quality of Life between Women Receiving Mastectomy or Breast Conserving Surgery in a Prospectively Recruited Cohort of Breast Cancer Patients. Curr Oncol 2022; 30:118-129. [PMID: 36661659 PMCID: PMC9857337 DOI: 10.3390/curroncol30010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
As rates of total mastectomy rise, the relationships between surgery modality with domains of health-related quality of life is not well understood. This study reports differences in depression, anxiety, pain, and health status among a cohort of women scheduled to receive total mastectomy or breast-conserving surgery. Patient-reported outcomes measured preoperative differences between patients receiving total mastectomy or breast-conserving surgery in a cross-sectional design. Regression analyses was used to model health outcomes and adjust for patient demographics on patient measures. Participants scheduled for total mastectomy were more likely to report more severe symptoms of depression and anxiety. This association was non-significant after adjusting for demographic differences. Younger participants were more likely to be scheduled for total mastectomy. Age was negatively associated with symptoms of depression and anxiety. Screening patients for mental health symptoms may be particularly important among younger patients who were more likely to report depression and anxiety before their surgery and were more likely to receive total mastectomy.
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Affiliation(s)
- Elaine McKevitt
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Maria Saleeb
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Rebecca Warburton
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Jin-Si Pao
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Carol Dingee
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Amy Bazzarelli
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Katelynn Tang
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Li Y, Guo J, Sui Y, Chen B, Li D, Jiang J. Quality of Life in Patients with Breast Cancer following Breast Conservation Surgery: A Systematic Review and Meta-Analysis. J Healthc Eng 2022; 2022:3877984. [PMID: 35140901 PMCID: PMC8820849 DOI: 10.1155/2022/3877984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 01/29/2023]
Abstract
To evaluate the health-related quality-of-life (QOL) outcomes in surgical breast cancer survivors who received breast conservation therapy (BCT) compared to mastectomy, we utilized a systematic review to conduct observational studies of QOL in patients with breast cancer following breast conservation therapy from their inception until October 2021. The PubMed, the Cochrane Library, and the Web of Science databases were systematically searched to retrieve the observational studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were applied as an effect estimate and calculated using Stata 15 software. Nine studies comprising 2301 patients were included. The results showed that no significant differences compared to mastectomy were detected for global health status (P=0.971 and P=0.613), physical function (P=0.099), emotional function (P=0.096), cognitive function (P=0.377), social function (P=0.602), sexual functioning (P=0.072), and sexual enjoyment (P=0.142), while role function (P=0.036), body image (P=0.000), and future perspective (P=0.012) showed a significant difference for BCT when compared to mastectomy. When compared to breast reconstruction (BR), the BCT group was inferior at physical function (P=0.002) and cognitive function (P=0.040) but superior at body image (P=0.001). When used the Functional Assessment of Cancer Therapy (FACT) tool, BCT has better results in physical function (P=0.000), emotional function (P=0.000), and social function (P=0.000) than mastectomy. QOL outcomes after BCT were better than mastectomy in body image, future perspective, and role function. BCT may be an acceptable option in the study setting for breast cancer patients who pursue high QOL.
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Affiliation(s)
- Yue Li
- Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jianming Guo
- Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin City, Heilongjiang Province, China
| | - Yuan Sui
- Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin City, Heilongjiang Province, China
| | - Baihui Chen
- Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin City, Heilongjiang Province, China
| | - Dalin Li
- Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jiakang Jiang
- Heilongjiang University of Chinese Medicine, No. 26 Heping Road, Xiangfang District, Harbin City, Heilongjiang Province, China
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Godden AR, Micha A, Wolf LM, Pitches C, Barry PA, Khan AA, Krupa KDC, Kirby AM, Rusby JE. Three-dimensional simulation of aesthetic outcome from breast-conserving surgery compared with viewing photographs or standard care: randomized clinical trial. Br J Surg 2021; 108:1181-1188. [PMID: 34370833 PMCID: PMC10364871 DOI: 10.1093/bjs/znab217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Over half of women with surgically managed breast cancer in the UK undergo breast-conserving treatment (BCT). While photographs are shown prior to reconstructive surgery or complex oncoplastic procedures, standard practice prior to breast conservation is to simply describe the likely aesthetic changes. Patients have expressed the desire for more personalized information about likely appearance after surgery. The hypothesis was that viewing a three-dimensional (3D) simulation improves patients' confidence in knowing their likely aesthetic outcome after surgery. METHODS A randomized, controlled trial of 117 women planning unilateral BCT was undertaken. The randomization was three-way: standard of care (verbal description alone, control group), viewing two-dimensional (2D) photographs, or viewing a 3D simulation before surgery. The primary endpoint was the comparison between groups' median answer on a visual analogue scale (VAS) for the question administered before surgery: 'How confident are you that you know how your breasts are likely to look after treatment?' RESULTS The median VAS in the control group was 5.2 (i.q.r. 2.6-7.8); 8.0 (i.q.r. 5.7-8.7) for 2D photography, and 8.9 (i.q.r. 8.2-9.5) for 3D simulation. There was a significant difference between groups (P < 0.010) with post-hoc pairwise comparisons demonstrating a statistically significant difference between 3D simulation and both standard care and viewing 2D photographs (P < 0.010 and P = 0.012, respectively). CONCLUSION This RCT has demonstrated that women who viewed an individualized 3D simulation of likely aesthetic outcome for BCT were more confident going into surgery than those who received standard care or who were shown 2D photographs of other women. The impact on longer-term satisfaction with outcome remains to be determined.Registration number: NCT03250260 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A R Godden
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- Independent patient co-designer, Institute of Cancer Research, Sutton, Surrey, UK
| | - A Micha
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - L M Wolf
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - C Pitches
- Independent patient co-designer, Institute of Cancer Research, Sutton, Surrey, UK
| | - P A Barry
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - A A Khan
- Department of Plastic Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - K D C Krupa
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - A M Kirby
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- Independent patient co-designer, Institute of Cancer Research, Sutton, Surrey, UK
| | - J E Rusby
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
- Independent patient co-designer, Institute of Cancer Research, Sutton, Surrey, UK
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Choong WL, Andrew RE, Hogg FJ, Munnoch DA, Pitsinis V, Macaskill EJ. Age and cancer treatment factors influence patient-reported outcomes following therapeutic mammoplasty and contralateral symmetrisation for the treatment of breast cancer. J Plast Reconstr Aesthet Surg 2021; 74:2557-2564. [PMID: 33875389 DOI: 10.1016/j.bjps.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncoplastic surgery for breast cancer has increased in popularity over the last few years, with oncological safety confirmed in several studies. There are, however, limited published data on patient-reported outcomes from this surgical approach. This study assessed patient-reported outcomes of satisfaction following therapeutic mammoplasty and contralateral symmetrisation (TMCS) as part of breast cancer treatment in relation to other patient and treatment factors. METHODS The validated BREAST-Q™ breast reduction module was sent to all surviving patients who had no documented cancer recurrence and had undergone TMCS in NHS Tayside between August 2013 and August 2017. The Q-score was used to analyse data and correlate with patient clinical information, surgical, pathology and treatment factors. Ethical approval was granted by the University of Dundee ethics committee. RESULTS The patient response rate to the study was 64.5% (60 of 93 patients), with a mean age of 59 years (range 41-75 years). In all domains, patients reported high levels of satisfaction with outcomes. There were strong correlations between domains with the exception of physical symptoms. Younger patients reported poorer outcomes in domains that related to satisfaction with outcomes of surgery, psychosocial aspects, sexual function and physical symptoms. Treatment with chemotherapy and/or trastuzumab and lymph node positivity were associated with poorer outcomes in a number of domains. CONCLUSIONS Our results demonstrate that patients report high levels of satisfaction after TMCS, but this is influenced by age. Patient-reported outcomes that include physical and psychosocial appear to be more strongly influenced by medical treatments than surgery.
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Affiliation(s)
- Wen Ling Choong
- Department of Breast Surgery, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom.
| | - Rosie E Andrew
- University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom
| | - Fiona J Hogg
- Department of Plastic Surgery, Level 5, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom
| | - D Alex Munnoch
- Department of Plastic Surgery, Level 5, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom
| | - Vassilis Pitsinis
- Department of Breast Surgery, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom
| | - E Jane Macaskill
- Department of Breast Surgery, Level 6, Ninewells Hospital and Medical School, Dundee, DD1 9SY United Kingdom
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Micha AE, Sinnett V, Downey K, Allen S, Bishop B, Hector LR, Patrick EP, Edmonds R, Barry PA, Krupa KDC, Rusby JE. Patient and clinician satisfaction and clinical outcomes of Magseed compared with wire-guided localisation for impalpable breast lesions. Breast Cancer 2020; 28:196-205. [PMID: 32974810 PMCID: PMC7796883 DOI: 10.1007/s12282-020-01149-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023]
Abstract
Background Guide-wire localisation remains the most commonly used technique for localisation of impalpable breast lesions in the UK. One alternative is magnetic seed localisation. We aimed to investigate patient and clinician satisfaction in two consecutive cohorts, describe re-excision and positive margin rates, and explore reasons for positive margins and the implications for localisation techniques. Methods A single-institution prospective service evaluation of two cohorts of consecutive cases of wire and then Magseed localisation was carried out. Data were collected on patient and clinician satisfaction, clinico-pathological findings, and causes of involved margins. T tests were used to compare continuous variables and Chi-squared test for satisfaction outcomes. Results 168 consecutive cases used wire-guided localisation (WGL) and 128 subsequent cases used Magseeds. Patients reported less anxiety between localisation and surgery in the Magseed group, and clinicians reported greater ease of use of Magseeds. There were no differences in lesion size, surgical complexity, or re-excision rate between the groups. In a subset of patients receiving standard wide local excision (i.e., excluding mammoplasties), the impact on margin involvement was investigated. There was no significant difference in radiological under-sizing or accuracy of localisation. However, specimen weight and eccentricity of the lesion were statistically significantly lower in the Magseed group. Despite this, re-excision rates were not significantly different (p = 0.4). Conclusions This is the first large study of satisfaction with localisation and showed clinician preference for Magseed and a reduction in patient anxiety. It also demonstrated similar positive margin rates despite smaller specimen weights in the Magseed group. Magnetic seed localisation offers an acceptable clinical alternative to guide wire localisation. The impact on local service provision should also be considered.
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Affiliation(s)
- Aikaterini E Micha
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Victoria Sinnett
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Kate Downey
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Steve Allen
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Briony Bishop
- Royal Marsden NHS Foundation Trust, London, UK
- Bedfordshire Hospitals NHS Trust, South Wing, Kempston Rd, Bedford, MK42 9DJ, UK
| | - Lauren R Hector
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Elaine P Patrick
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | | | - Peter A Barry
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
- Institute for Cancer Research, Sutton, UK
| | - Katherine D C Krupa
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK
| | - Jennifer E Rusby
- Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, Surrey, UK.
- Institute for Cancer Research, Sutton, UK.
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Baliski C, Hamm J. Does receipt of preference sensitive care impact patient reported outcomes following breast cancer surgery? Am J Surg 2020; 219:746-749. [PMID: 32199602 DOI: 10.1016/j.amjsurg.2020.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with early breast cancer have multiple surgical options, with their choice being based on personal values, and ultimately being preference sensitive. Most patients will choose breast conserving surgery (BCS) as their preferred management, with some ultimately requiring mastectomy. These patients may have lower satisfaction with this approach than others choosing mastectomy as their preferred option. METHODS The BREAST-Q patient reported outcomes (PRO) measurement tool was retrospectively administered to patients undergoing mastectomy. RESULTS Patients choosing an index mastectomy had higher satisfaction with breasts score than those originally having BCS (58.0 vs 44.0; p = 0.012). Quality of life domains were also higher in those originally choosing a mastectomy, including: psychosocial (72.5 vs 63.0; p = 0.019), sexual (48.0 vs 36.0; p = 0.042), and physical well being of the chest domains (80.0 vs 72.0; p = 0.031). CONCLUSION Patients undergoing mastectomy after initial breast conserving surgery report lower PRO's than those initially choosing mastectomy. This suggests that patient preferences need to be considered when interpreting PRO's following breast cancer surgery.
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Affiliation(s)
- Christopher Baliski
- Dept. of Surgical Oncology, SAH-CSI BC Cancer, Kelowna, BC, Canada; Department of Surgery, UBCO, Kelowna, BC, Canada.
| | - Jeremy Hamm
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver, BC, Canada
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Kaur M, Pusic AL, Cano SJ, Xie F, Bordeleau L, Zhong T, Klassen A. International phase 1 study protocol to develop a health state classification system for a preference-based measure for women with breast cancer: the BREAST-Q Utility module. BMJ Open 2020; 10:e034451. [PMID: 31915176 PMCID: PMC6955575 DOI: 10.1136/bmjopen-2019-034451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Concerns unique to women with breast cancer can include impact of cancer on body image, sexual well-being and changes in breast appearance and sensation. These important issues are not captured by the existing generic preference-based measures (PBMs) and no breast cancer-specific PBM currently exists. This Phase 1 protocol describes a mixed-methods study to develop and validate the descriptive health state classification system for a breast cancer-specific PBM, called the BREAST-Q Utility module. METHODS AND ANALYSIS A heterogeneous sample of women aged 18 years and older diagnosed with breast cancer who are undergoing or have had treatment for breast cancer will be invited to participate in qualitative interviews. Participants will be asked to describe impact of their diagnosis and treatment(s) on their health-related quality of life (HRQOL). Interviews will be audio recorded, transcribed verbatim and coded using a line-by-line approach. At the end of each interview, based on each participant's cancer treatment history, patients will complete the mastectomy, breast-conserving therapy or reconstruction module of BREAST-Q, with modified 5-point Likert scale to measure importance of the BREAST-Q concepts. Both sources of data will be analysed to identify the most important HRQOL concerns.A conceptual framework and item pool will be developed from the qualitative dataset. Preliminary version of the BREAST-Q Utility module will be created and refined at an in-person meeting of multidisciplinary experts. Content validity of the Utility module will be examined (cognitive debriefing, expert feedback). Psychometric properties of Utility module will be evaluated in a large sample of women with breast cancer. ETHICS AND DISSEMINATION The study has been approved by Hamilton Integrated Research Ethics Board, Canada. Results of this study will be presented at international conferences and published in peer-reviewed journals.
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Affiliation(s)
- Manraj Kaur
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Feng Xie
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Louise Bordeleau
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Toni Zhong
- Plastic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anne Klassen
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Yüksel E, Güven HE, Dogan L. Patients' Perspective: What has Changed in Deciding about Breast-Conserving Surgery for Early-Stage Breast Cancer in Turkey? Oncol Res Treat 2018; 41:744-749. [PMID: 30419566 DOI: 10.1159/000492586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to describe patients' perception of early breast cancer, factors influencing the choice of operation, patients' sources of information about the disease and the seriousness with which this information is considered, and to address what surgeons can do to enlighten their patients prior to decision-making. METHODS Patients were asked to complete a questionnaire consisting of 3 sections: The first section addressed influential factors during the decision-making process; the second pertained to the role of surgeons or health facilities in the process; and the third asked patients to revisit their initial choice of surgery. RESULTS 237 patients were included in the study. Statistical analyzes regarding demographic features showed that nulliparous, younger than 50 years, never or <5 years married, highly educated, business-owning, employed, and stage I breast cancer patients preferred breast-conserving surgery (BCS) to mastectomy. CONCLUSION Although the rate of BCS is a technical quality indicator for breast cancer centers, providing sufficient patient counseling, involving the patient in the decision-making process, and offering every possible surgical option are key to improving quality of life. Systematic counseling should be provided to breast cancer patients who have primary tumors that are eligible for BCS.
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Abstract
INTRODUCTION Breast cancer and its treatment change the perception of mastectomized women of their physical appearance, which leads to depression and has a negative effect on the overall quality of life of those woman. AIM We wanted to assess the quality of life and the degree of depression of patients suffering from breast cancer, on the basis of a standardised questionnaire to assess the patients' quality of life (QLQ-C-30 BR-23), and the degree of depression using Beck's Depression Inventory (BDI, II). MATERIALS AND METHODS The research was conducted on a sample of 160 patients, who were surveyed before and after the surgical procedure. The inclusion criteria for the research were: patients suffering from breast cancer aged between 18 and 70 years, cancer diagnosed by FNB or CORE biopsy. The patients were divided into two groups: patients having breast-conserving surgery and patients having radical surgical treatment. RESULTS There were 47 or 39.37% patients who underwent breast-conserving surgery and 113 or 70.62% patients who underwent radical surgery. The results of the survey conducted show that there was no difference in the quality of life of patients before and after surgery, regardless of the type of surgical procedure undertaken. However, there was a significant different in the degree of depression between patients subjected to different surgical procedures, where the patients surveyed post-surgery after radical mastectomy showed a higher degree of depression than the patients surveyed after breast-conserving surgery. CONCLUSION There is no difference in the quality of life before and after surgery, regardless of the type of operation. However, there is a significant difference in the degree of depression in patients after radical mastectomy, who showed a higher degree of depression than the surveyed patients who underwent breast-conserving surgery.
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Affiliation(s)
- Mirhan Salibasic
- Clinic for Abdominal Surgery, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Samir Delibegovic
- Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina
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O'Connell RL, Di Micco R, Khabra K, Wolf L, deSouza N, Roche N, Barry PA, Kirby AM, Rusby JE. The potential role of three-dimensional surface imaging as a tool to evaluate aesthetic outcome after Breast Conserving Therapy (BCT). Breast Cancer Res Treat 2017; 164:385-393. [PMID: 28447239 PMCID: PMC5487698 DOI: 10.1007/s10549-017-4256-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/17/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE To establish whether objective measurements of symmetry of volume and shape using three-dimensional surface imaging (3D-SI) can be used as surrogate markers of aesthetic outcome in patients who have undergone breast conserving therapy (BCT). METHODS Women who had undergone unilateral BCT in the preceding 1-6 years were invited to participate. Participants completed a satisfaction questionnaire (BREAST-Q) and underwent 3D-SI. Volume and surface symmetry were measured on the images. Assessment of aesthetic outcome was undertaken by a panel of clinicians. The Kruskal-Wallis test was used to assess the relationship between volume and shape symmetry measurements with the panel score. Spearman's rho correlations were used to assess the relationship between the measurements and patient satisfaction. RESULTS 200 women participated. Median volume symmetry was 87% (IQR 78-93) and shape symmetry was 5.9 mm (IQR 4.2-8.0). The participants were grouped according to panel assessment of aesthetic outcome (poor, fair, good, excellent) and the median volume and shape symmetry was calculated for each group. Volume symmetry significantly differed between the groups. Post hoc pairwise comparisons demonstrated that these differences existed between panel scores of fair versus good and good versus excellent. Median shape symmetry also differed according to patient panel groups with four significant pairwise comparisons between poor versus good, poor versus excellent, fair versus good and fair versus excellent. There was a significant but weak correlation of both volume symmetry and surface asymmetry with BREAST-Q scores (correlation coefficients 0.187 and -0.229, respectively). CONCLUSION Breast volume and shape symmetry are both associated with panel assessment scores and patient satisfaction. The objective volume and shape symmetry measures were strongly associated with panel assessment scores, such that a 3D-SI tool could replace panel assessment as a faster and more objective method of evaluating aesthetic outcomes.
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Affiliation(s)
- Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Rosa Di Micco
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
- Department of Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Komel Khabra
- Department of Statistics, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Lisa Wolf
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Nandita deSouza
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Nicola Roche
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Anna M Kirby
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Jennifer E Rusby
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK.
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12
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Fuzesi S, Cano SJ, Klassen AF, Atisha D, Pusic AL. Validation of the electronic version of the BREAST-Q in the army of women study. Breast 2017; 33:44-49. [PMID: 28279888 PMCID: PMC5551502 DOI: 10.1016/j.breast.2017.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/04/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery-specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach's α coefficients (≥0.78) and item-total correlations (range of means, 0.65-0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.
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Affiliation(s)
- Sarah Fuzesi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Stefan J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - Anne F Klassen
- McMaster University, 3N27, 1200 Main Street W, Hamilton, ON L8N 3Z5, Canada
| | - Dunya Atisha
- Henry Ford Health System, 2799 W. Grand Blvd, K-16, Detroit, MI 48202, USA
| | - Andrea L Pusic
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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13
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Butow P, Tesson S, Boyle F. A systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast 2016; 26:31-45. [PMID: 27017240 DOI: 10.1016/j.breast.2015.12.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023] Open
Abstract
Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.
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Affiliation(s)
- Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Stephanie Tesson
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia
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14
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Szutowicz-Wydra B, Wydra J, Kruszewski WJ, Ciesielski M, Szajewski M, Walczak J, Hansdorfer-Korzon R. Same Quality of Life for Polish Breast Cancer Patients Treated with Mastectomy and Breast Reconstruction or Breast-Conserving Therapy. Polish Journal of Surgery 2016; 88:264-269. [PMID: 27811351 DOI: 10.1515/pjs-2016-0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 11/15/2022]
Abstract
AbstractBreast 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.
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15
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Peerawong T, Phenwan T, Supanitwatthana S, Mahattanobon S, Kongkamol C. Breast Conserving Therapy and Quality of Life in Thai Females: a Mixed Methods Study. Asian Pac J Cancer Prev 2016; 17:2917-2921. [PMID: 27356712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). MATERIALS AND METHODS In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. RESULTS Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. CONCLUSIONS Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.
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Affiliation(s)
- Thanarpan Peerawong
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand E-mail :
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Klit A, Henriksen TF, Siersen HE, Elberg JJ, Christiansen P, Kroman N. [Oncoplastic breast surgery in Denmark]. Ugeskr Laeger 2014; 176:V06130376. [PMID: 25353999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With improved survival rates after breast cancer treatment, more attention is drawn to improve the cosmetic outcome after surgical treatment of breast cancer. In this process the oncoplastic breast surgery was conceived. It supplements the traditional surgical treatments (mastectomy and breast conserving surgery) with increased focus on individualized therapy. The ambition is to obtain the best possible cosmetic outcome without compromising recurrence rates and survival. This article provides an overview of the current oncoplastic breast surgery treatment offered in Denmark.
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17
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Klit A, Henriksen TF, Siersen HE, Elberg JJ, Christiansen P, Kroman N. [Oncoplastic breast surgery in Denmark]. Ugeskr Laeger 2013; 175:V06130376. [PMID: 25353190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With improved survival rates after breast cancer treatment, more attention is drawn to improve the cosmetic outcome after surgical treatment of breast cancer. In this process the oncoplastic breast surgery was conceived. It supplements the traditional surgical treatments (mastectomy and breast conserving surgery) with increased focus on individualized therapy. The ambition is to obtain the best possible cosmetic outcome without compromising recurrence rates and survival. This article provides an overview of the current oncoplastic breast surgery treatment offered in Denmark.
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Affiliation(s)
- Anders Klit
- Klinik for Plastikkirurgi, Brystkirurgi og Brandsårbehandling, Rigshospitalet, Aarhus Universitetshospital.
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18
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Shaffer VA, Hulsey L, Zikmund-Fisher BJ. The effects of process-focused versus experience-focused narratives in a breast cancer treatment decision task. Patient Educ Couns 2013; 93:255-64. [PMID: 23962673 DOI: 10.1016/j.pec.2013.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 07/09/2013] [Accepted: 07/23/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine the effect of patient narratives that discuss decision processes versus patient experiences on decisions about treatments for early stage breast cancer. METHODS We recruited 300 women with no previous history of breast cancer to imagine that they had been diagnosed with early stage breast cancer and to choose between mastectomy and lumpectomy with radiation. Before learning about their treatment options, participants were randomly assigned to one of four conditions with videotaped stories from fictitious cancer survivors, using a 2 (content: experience versus process) × 2 (emotional valence: positive only vs. positive and negative) factorial design, or a control condition with no stories. We measured information search, treatment intentions, and decision satisfaction. RESULTS Participants viewing process narratives spent more time searching for information. Participants viewing experience narratives reported a greater ability to imagine what it was like to experience the treatments; they also evaluated their decision more positively on several dimensions. CONCLUSIONS Process narratives appeared to guide information search, and experience narratives improved evaluations of the decision process. PRACTICE IMPLICATIONS There is no evidence that process and experience narratives 'bias' decisions in the same manner as outcome narratives. Further, their potential to focus patient attention on key information and increase patient confidence in decision making appears significant.
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Affiliation(s)
- Victoria A Shaffer
- Department of Health Sciences and Department of Psychological Sciences, University of Missouri, Columbia, USA.
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19
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Medina-Franco H, Rojas-García P, Suárez-Bobadilla YL, Sánchez-Ramón A. Factors associated with breast symmetry after breast conserving surgery for cancer. Rev Invest Clin 2013; 65:379-383. [PMID: 24687336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/13/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Breast-conserving surgery (BCS) is the standard of care for treatment of early breast cancer. Factors associated with poor cosmetic results are not well described. The aim of the present study was to evaluate factors associated with breast asymmetry after BCS for invasive breast cancer. MATERIAL AND METHODS Patients who underwent unilateral BCS for invasive breast cancer and completed at least six months after radiation therapy were included. After informed consent, patients answered a validated questionnaire for breast symmetry. Demographic, clinical-pathological and surgical variables were recorded. Bilateral breast volume was measured in office and volume difference > 20% was considered objective asymmetry. Variables were analyzed with χ(2) test and significance was considered at p < 0.05. RESULTS One-hundred and thirtythree patients were included. Mean patient age was 56 ± 9 years. Most patients were married (78%) with educational level of high school or greater (50.8%). Mean body mass index (BMI) was 25 ± 8. Twelve percent of patients underwent ≥ 2 surgical procedures. Eighty-one percent of patients had tumors > 1 cm. Twenty-two percent of patients had objective breast asymmetry and 27% perceived themselves with asymmetry. There were no significant relationship between objective and subjective asymmetry. The only variable significantly associated with perception of breast asymmetry was educational level ≥ high school. CONCLUSIONS There was no relationship between subjective and objective breast asymmetry after BCS, suggesting that cosmetic results are mainly related to patient subjective perception. The only variable associated with subjective breast asymmetry was high educational level, possibly because higher cosmetic expectations in this group of patients.
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Affiliation(s)
- Heriberto Medina-Franco
- Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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20
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Lyngholm CD, Christiansen PM, Damsgaard TE, Overgaard J. Long-term follow-up of late morbidity, cosmetic outcome and body image after breast conserving therapy. A study from the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol 2013; 52:259-69. [PMID: 23215829 DOI: 10.3109/0284186x.2012.744469] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED The Danish Breast Cancer Cooperative Group (DBCG) introduced BCT as a standard treatment in Denmark in 1990. The aim of this study was to investigate late morbidity, cosmetic outcome, and body image after BCT and to associate these outcome variables with patient, tumor, and treatment characteristics. MATERIAL AND METHODS A total of 214 patients treated with BCT from 1989-2002 participated in a long-term follow-up visit comprising an interview, clinical examination, photos of the breast region and completion of a questionnaire on Body Image. RESULTS Median follow-up time was 12 years (range 7-20). Moderate to severe fibrosis was found in 23% of patients and was associated with chemotherapy [OR 2.6, CI (1.1; 5.9), p = 0.02], large breast size [OR 3.2, CI (1.6; 6.4), p = 0.001], and smoking [OR 2.4, CI (1.1; 4.9), p = 0.02]. Patients with a satisfactory cosmetic outcome, when assessed by a clinician, were characterized by small tumors [OR 3.2, CI (1.5; 6.8), p = 0.003] and small to medium sized breasts [OR 2.0, CI (1.1; 3.5), p = 0.002]. Fifty percent of patients scored good or excellent when assessed by a clinician compared to 88% when reported by the patients themselves. Patients satisfied with their own cosmetic outcome were the younger patients [< 50 years; OR 3.2, CI (1.1; 8.6), p = 0.03] with no postoperative complications [OR 3.3, CI (1.2; 9.2), p = 0.02]. Regarding body image 15% felt less feminine, 25% felt less sexually attractive, and 28% of patients had changed their clothing habits as a result of the disease or treatment. CONCLUSION The majority of patients were satisfied with their cosmetic outcome after BCT, whereas only half of the patients were found to have a good or excellent cosmetic outcome when assessed by the clinician. Body image was found to be only minimally disturbed in the majority of patients. The level of moderate to severe fibrosis was acceptable compared to both national and international studies with similar patient compositions.
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Affiliation(s)
- Christina D Lyngholm
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
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21
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Eichler C, Kolsch M, Sauerwald A, Bach A, Gluz O, Warm M. Lumpectomy versus mastopexy--a post-surgery patient survey. Anticancer Res 2013; 33:731-736. [PMID: 23393375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In oncoplastic surgery, post-surgical subjective outcome evaluation is usually performed for patients with breast-conserving surgery and patients with mastectomy. This study attempts to broaden the spectrum by comparing mastopexy (MP) and lumpectomy (BCS). Evaluating this aspect is important, since performing a mastopexy along with tumor removal offers a chance for simultaneous breast enhancement, thus possibly offering a more beneficial subjective outcome. Both procedures were used to remove single-locus tumors. A total of 143 patients, 71 of which answered a questionnaire regarding post-surgical body image, were evaluated. RESULTS Post-surgical patient evaluation showed the following results: A "very satisfactory" or "satisfactory" outcome was achieved in 87% of BCS cases and 86% of MP cases. No significant difference was established here (p=0.48). Evaluation of overall cosmetic outcome, scar tissue formation, shape and size of the breast and overall quality of life were answered positively in both groups. Regarding the remaining superficial scar tissue, patients answered as being satisfied with the result in 85% of BCS cases and 79% of MP cases. A significant difference was established between the very satisfied (77% BCS/44% MP) and satisfied (8% BCS/35% MP) group (p=0.013). Post-surgical swelling, nipple sensitivity and overall quality of life did not differ significantly. CONCLUSION Simple lumpectomy, i.e. classic BCS, leads to less scar tissue and involves a shorter surgical procedure, both of which may be considered as arguments for performing BCS. Scar tissue formation was more positively evaluated in the BCS group, where 77% of patients were "very satisfied" and 8% "satisfied". The other evaluated parameters did not differ significantly. MP may be offered as an option when simultaneous breast enhancement is desired at little cost to post-surgical patient satisfaction.
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Affiliation(s)
- Christian Eichler
- Brustzentrum, Krankenhaus Holweide, Neufelder Str. 32, 51067 Köln, Germany.
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Nagel G. [Patient's competency...and as required]. Rev Med Suisse 2012; 8:194. [PMID: 22338512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- G Nagel
- Stiftung Patientenkompetenz und Brustzentrum, Facharzt Onkologie Brust-Zentrum, Seefeldstrasse 214, 8008 Zürich.
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Medina-Franco H, García-Alvarez MN, Rojas-García P, Trabanino C, Drucker-Zertuche M, Arcila D. Body image perception and quality of life in patients who underwent breast surgery. Am Surg 2010; 76:1000-1005. [PMID: 20836351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Quality of Life (QoL) has become a standard measure in assessing the effectiveness of medical interventions. We compared the differences between QoL and body image scale (BIS) in a group of patients who underwent breast surgery, including lumpectomy or conservative surgery, modified radical mastectomy and radical mastectomy with breast reconstruction. We included patients who underwent breast surgery between August of 2005 and June of 2006 in two tertiary referral centers in Mexico City. Two self-administered questionnaires assessing body image perception, BIS and quality of life (SF-36), were assigned and a physician-conducted interview was done. We stratified patients by age, marital status, and scholar grade. The sample comprised 202 patients. The BIS results yielded: the group with a benign lesion demonstrated favorable body image perception when compared with the malignant lesion group. A confirmed diagnosis of malignancy hinders QoL in older and younger age groups. Conservative surgery and breast reconstruction improves QoL in younger patients without significance in the older group. The most significant variable that hinders the BIS and QoL is the cancer diagnosis. Impact of conservative surgery and breast reconstruction in body image perception and quality of life is influenced by patient age and educational level.
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Affiliation(s)
- Heriberto Medina-Franco
- Department of Surgery, Surgical Oncology Section, National Institute of Medical Sciences and Nutrition Salvador Zubirán, México.
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Sheppard VB, Williams KP, Harrison TM, Jennings Y, Lucas W, Stephen J, Robinson D, Mandelblatt JS, Taylor KL. Development of decision-support intervention for Black women with breast cancer. Psychooncology 2010; 19:62-70. [PMID: 19267384 PMCID: PMC3136087 DOI: 10.1002/pon.1530] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women. METHODS Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors. RESULTS Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer. CONCLUSION Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment.
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Affiliation(s)
- Vanessa B. Sheppard
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Karen Patricia Williams
- Michigan State University, Obstetrics Gynecology & Reproductive Biology, 224D W Fee Hall, East Lansing, MI 48824-1315, 517-432-4790 (phone)
| | - Toni Michelle Harrison
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Yvonne Jennings
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Wanda Lucas
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Juleen Stephen
- Virginia Polytechnic Institute and State University, Department of Health Promotion, 206 War Memorial Hall, Blacksburg, VA 24061, 540-231-5029 (phone)
| | - Dana Robinson
- Sisters from the Heart, Washington, D.C., 5100 Auth Way, Suitland, MD 20747, 202-564-8018
| | - Jeanne S. Mandelblatt
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Kathryn L. Taylor
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
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Parmar V, Nadkarni MS, Kakade A, Hawaldar R, Badwe RA. Does the patient's opinion differ from the clinicians' regarding breast cosmesis after BCT? Breast J 2009; 16:103-4. [PMID: 19929893 DOI: 10.1111/j.1524-4741.2009.00859.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Colombo G, Dellacasa I, Ruvolo V, Ottonello M, Bormioli M, Meszaros P. [Oncoplastic surgery for the treatment of breast cancer]. Minerva Ginecol 2009; 61:439-444. [PMID: 19749675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Surgery is still the gold standard in breast cancer. Also if the elective treatment, thanks to the adjuvant therapy, ha became more conservative than once was, breast surgery remains, in the mind of the woman affected by breast cancer, a demolitive surgery. The collaboration bet-ween the breast surgeon and the plastic surgeon has to be closer than it is, in order to obtain the total asportation of the tumor and an esthetic result that limits the psychological trauma to the woman. Oncoplastic surgery is the answer to these human and medical necessities, giving the correct approaches about breast volume, tumor volume, radicality of the treatment and esthetic outcome. This review will focus on different oncoplastic approaches, to help improving both the esthetic outcome of breast cancer resection and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy.
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Affiliation(s)
- G Colombo
- Dipartimento di Chirurgia Plastica e Ricostruttiva, Università di Genova, Genova, Italia.
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Shoma AM, Mohamed MH, Nouman N, Amin M, Ibrahim IM, Tobar SS, Gaffar HE, Aboelez WF, Ali SE, William SG. Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients. World J Surg Oncol 2009; 7:66. [PMID: 19678927 PMCID: PMC2739851 DOI: 10.1186/1477-7819-7-66] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 08/13/2009] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In most developing countries, as in Egypt; postmenopausal breast cancer cases are offered a radical form of surgery relying on their unawareness of the subsequent body image disturbance. This study aimed at evaluating the effect of breast cancer surgical choice; Breast Conservative Therapy (BCT) versus Modified Radical Mastectomy (MRM); on body image perception among Egyptian postmenopausal cases. METHODS One hundred postmenopausal women with breast cancer were divided into 2 groups, one group underwent BCT and the other underwent MRM. Pre- and post-operative assessments of body image distress were done using four scales; Breast Impact of Treatment Scale (BITS), Impact of Event Scale (IES), Situational Discomfort Scale (SDS), and Body Satisfaction Scale (BSS). RESULTS Preoperative assessment showed no statistical significant difference regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects. CONCLUSION Body image is an important factor for postmenopausal women with breast cancer in developing countries where that concept is widely ignored. We should not deprive those cases from their right of less mutilating option of treatment as BCT.
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Affiliation(s)
| | | | | | - Mahmoud Amin
- Surgery Department, Mansoura University Hospital, Egypt
| | | | - Salwa S Tobar
- Psychiatric Department, Mansoura University Hospital, Egypt
| | - Hanan E Gaffar
- Psychiatric Department, Mansoura University Hospital, Egypt
| | | | - Salwa E Ali
- Medical Surgical Department, Alexandria Faculty of Nursing, Egypt
| | - Soheir G William
- Medical Surgical Department, Alexandria Faculty of Nursing, Egypt
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Schnur JB, Montgomery GH, Hallquist MN, Goldfarb AB, Silverstein JH, Weltz CR, Kowalski AV, Bovbjerg DH. Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery. Int J Behav Med 2008; 15:21-8. [PMID: 18444017 DOI: 10.1007/bf03003070] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Psychological distress is a central experience for women facing diagnostic and curative breast cancer surgery. PURPOSE The present study was designed to predict anticipatory distress in 187 women scheduled to undergo excisional breast biopsy or lumpectomy. METHOD Participants completed questionnaires assessing emotional distress and predictors of this distress (surgery type, worry about the surgical procedure, and worry about what the surgeon will find). RESULTS The study found that lumpectomy patients experienced greater anticipatory distress than excisional breast biopsy patients on three of the four distress measures (all ps < 0.05) and that worry about what the surgeon might find partially mediated these effects. CONCLUSION The results suggest that although women awaiting lumpectomy are more distressed than women awaiting biopsy, both groups report substantial distress, and, consequently, psychosocial interventions are recommended for both groups.
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Lee TS, Kilbreath SL, Refshauge KM, Pendlebury SC, Beith JM, Lee MJ. Quality of life of women treated with radiotherapy for breast cancer. Support Care Cancer 2007; 16:399-405. [PMID: 17876610 DOI: 10.1007/s00520-007-0328-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 08/21/2007] [Indexed: 12/24/2022]
Abstract
GOALS OF WORK Radiotherapy is routinely used in the treatment of early breast cancer, particularly in women who have undergone lumpectomy. Its impact on the quality of life of patients is important and is taken into consideration when making informed choices about treatment from both a patient's and health professional's point of view. This study reports on the quality of life of women at baseline, the completion of radiotherapy and 7 months after the completion of radiotherapy. MATERIALS AND METHODS European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C-30 and BR-23 questionnaires were used to evaluate quality of life of 61 women treated with radiotherapy for breast cancer. Additionally, demographic and treatment variables were analysed in relation to quality of life outcomes to determine if there were any significant predictors of quality of life. MAIN RESULTS There was no difference in quality of life of women at baseline, completion and 7 months after completion of radiotherapy. Fatigue and breast symptoms increased during radiotherapy but returned to baseline levels at 7 months. Fatigue was the strongest predictor of poor quality of life in women after radiotherapy. CONCLUSION Women retain a high quality of life and return to baseline function by 7 months after radiotherapy. Treatment may best be targeted to alleviate fatigue and breast symptoms during radiotherapy.
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Affiliation(s)
- T S Lee
- School of Physiotherapy, University of Sydney,Lidcombe, Australia.
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Salmon P, Holcombe C, Clark L, Krespi R, Fisher J, Hill J. Relationships with clinical staff after a diagnosis of breast cancer are associated with patients' experience of care and abuse in childhood. J Psychosom Res 2007; 63:255-62. [PMID: 17719362 DOI: 10.1016/j.jpsychores.2007.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 03/05/2007] [Accepted: 05/01/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Patients experiencing the crisis of the diagnosis and treatment of breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We tested the prediction that women recalling childhood abuse and lack of parental care would experience poorer support from clinical staff caring for them around the time of diagnosis and surgical treatment of breast cancer. METHODS Two to 4 days after surgery, women with primary breast cancer (N=355) self-reported: childhood sexual, physical, and emotional abuse and parental care; perceived social support; support experienced from the surgeon and breast and ward nurses; and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care and on current social support, controlling for emotional distress and age. RESULTS Women who reported feeling fully supported by clinical staff were more likely to recall no abuse and good parental care. The influence of parental care, but not abuse, was explained by its association with experiencing good social support generally, which was itself associated with feeling fully supported by clinical staff. These relationships were independent of current emotional distress. CONCLUSION Patients' ability to feel fully supported by clinical staff reflects not only how much support staff make available but also patients' experience of close relationships in childhood. We suggest that, whereas lack of parental care compromises adult supportive relationships in general, abuse specifically reduces support from clinical staff.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom.
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Chang JTC, Chen CJ, Lin YC, Chen YC, Lin CY, Cheng AJ. Health-Related Quality of Life and Patient Satisfaction After Treatment for Breast Cancer in Northern Taiwan. Int J Radiat Oncol Biol Phys 2007; 69:49-53. [PMID: 17482771 DOI: 10.1016/j.ijrobp.2007.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 02/12/2007] [Accepted: 02/14/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. METHODS AND MATERIALS Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n = 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. RESULT There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). CONCLUSIONS Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves.
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Affiliation(s)
- Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.
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Abstract
Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making.
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Affiliation(s)
- Bonnie J F Meyer
- Department of Educational and School Psychology and Special Education, University Park Campus, Pennsylvania State University, University Park, PA 16802, USA.
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Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, Schechter C, Graff-Zivin J, Tatrow K, Price DD, Silverstein JH. A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients. J Natl Cancer Inst 2007; 99:1304-12. [PMID: 17728216 DOI: 10.1093/jnci/djm106] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. METHODS We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review. RESULTS Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time. CONCLUSIONS Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.
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Affiliation(s)
- Guy H Montgomery
- Department of Oncological Sciences, Mount Sinai School of Medicine, Box 1130, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA.
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Abstract
Breast cancer surgery is an emotive topic and rather than just simple cosmetic issues, the final appearance of the operated breast has been shown to have a significant impact on psychologic well-being and overall quality of life. Wide local excision (WLE) is a popular conservative approach to small tumors, which do not involve the nipple-areolar complex. This study compares WLE via an anterior and lateral approach. A retrospective survey of patient satisfaction was performed using a recognized and validated Body Image Score (BIS), which was sent to a total of 267 patients who had undergone WLE by either the anterior or lateral approach. The response rate was 57%, of which 89 women had undergone surgery via the anterior and 80 by the lateral approach. There was no significant difference in BIS when comparing the anterior and lateral approaches, despite concerns regarding the physical appearance of the scar and postoperative breast expressed by patients. Generally, surgery on the upper part of the breast was associated with less satisfaction than the lower, but "hiding" the scar with a lateral approach did not improve satisfaction. Surgeons should be reassured that the approach to WLE of early breast cancers has no impact on the patients overall body image and that the choice of technique should be based on the patient's personal preference and the surgeons experience and skill.
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Affiliation(s)
- Menelik Lee
- Department of Surgery, Kent and Sussex Hospital, Royal Tunbridge Wells, Kent, United Kingdom
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Abstract
BACKGROUND In the last decades, there have been no studies carried out in Lithuania on the quality of life of breast cancer patients. The aim of the present study was to evaluate changes in the quality of life of Lithuanian women with the early stage of breast cancer nine months after surgery and its dependence on surgical strategy, adjuvant chemotherapy and the social and demographic status of the patients. METHODS Seventy-seven patients with early stage breast cancer filled in the FACT-An questionnaire twice: one week and nine months after the surgery. The main age of the patients was 53.1 +/- 10.6 years. We distinguished the mastectomy group and breast conserving treatment (BCT) group with/without chemotherapy. The groups were identical in their social and demographic status (age, education, occupation and marital status). Changes in the quality of life in these groups were compared nine months after surgery. RESULTS Nine months after surgery, the overall quality of life was found worse in both mastectomy and BCT groups. Changes were induced by the worsening of the emotional and social well-being. The quality of life became worse in the mastectomy plus chemotherapy sample. No changes were detected in the mastectomy group without chemotherapy. In addition, the multivariate analysis showed that the marital status was quite a significant determinant of the functional well-being. CONCLUSION Nine months after surgery, the study revealed a worsening of the overall quality of life in both groups of patients--those who had undergone mastectomy and BCT. The quality of life became considerably worse in the mastectomy plus chemotherapy group. Marital status was found to exert the most considerable influence on the women's quality of life in comparison with other social and demographic factors.
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Affiliation(s)
- Giedre Bulotiene
- Department of Physical Medicine and Rehabilitation, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Jonas Veseliunas
- Department of Physical Medicine and Rehabilitation, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Valerijus Ostapenko
- Department of Breast Surgery and Oncology, Institute of Oncology, Vilnius University, Vilnius, Lithuania
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Abstract
The study assessed whether a nursing intervention based on self-regulation theory, the Attentional Focus and Symptom Management Intervention (AFSMI), could help women who underwent day surgery for breast cancer to achieve better pain management and decreased emotional distress. The sample consisted of 117 patients with breast cancer who were outpatients and undergoing surgery as part of the initial treatment for their cancer. All subjects were interviewed at three different occasions. The subjects were randomized into the experimental group (n = 61) or the usual care group (control, n = 56). The subjects in the experimental group received the intervention in two sessions, 3-4 days and 10-11 days after surgery. The outcomes were the subjects' pain and emotional distress. Results showed significant differences between the experimental and control group at post-test on home management, total mood disturbance, confusion and tension scores implying that the intervention was effective in achieving these outcomes. Clinical significance has illustrated that a nursing intervention applied during immediate recovery of breast cancer surgery is quite clinically relevant to reduce emotional distress. Self-regulation theory could effectively be used as a guide in developing nursing intervention programs in practice for patients with cancer undergoing day surgery as a primary treatment.
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Affiliation(s)
- Nicole Allard
- University of Quebec in Rimouski, Campus de Lévis, 55 Mont-Marie, Lévis, Quebec.
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Abstract
Breast-conserving treatment (BCT) is considered preferable to radical or modified radical mastectomy (MRM) for most women diagnosed with early-stage breast cancer. Studies have found that Chinese-American women are more likely to be treated with MRM, regardless of age or stage of disease. The central question posed in this study is: what are the cultural factors that influence the selection of treatments by Chinese-American patients and the presentation of treatment options by providers? Focused group discussions, semi-structured interviews, and ethnographic observations were conducted with 69 Chinese-American women and 14 health professionals. Results indicated that (1) many Chinese-American women, regardless of age, migration status, education, and income level, expressed a preference for MRM because it was seen as safer; (2) this was primarily a communal belief that even women who had BCT felt pressure to conform to; (3) some women felt pressured into the BCT decision by their physician and/or were unhappy with their choice; (4) patient and physician bias and difficulties with translation issues and supplemental materials all led to cross-cultural miscommunication; and (5) this miscommunication was cited as a reason for (a) not completing treatment regimes or (b) drastic changes in the treatment selected.
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Molenaar S, Sprangers M, Oort F, Rutgers E, Luiten E, Mulder J, van Meeteren M, de Haes H. Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer? Patient Educ Couns 2007; 65:122-30. [PMID: 16945498 DOI: 10.1016/j.pec.2006.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Accepted: 06/27/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE It is thought that patients fare better when they participate in treatment decision-making, and when they have more control over the amount and type of information they receive. To facilitate informed decision-making, interactive decision aids have been introduced in health care. This article describes how much, and which information patients select from an interactive decision aid on breast cancer. To explore whether the interactive system facilitates that different patients receive different information, associations between patients' characteristics and information selection are inspected. METHODS The interactive decision aid was provided to 106 patients after an initial discussion with their surgeon about their diagnosis and treatment options. Information regarding patients' age, completed education, treatment preference, psychological functioning, decision uncertainty and decision style was collected with a written, structured questionnaire. The questionnaire was completed before patients used the interactive decision aid. To create categories, a median-split procedure was employed on the scores of the continuous background variables. The information patients selected from the interactive decision aid were registered into logfiles. Associations between patients' background variables and information selection were investigated by means of univariate statistics. RESULTS Patients (n=97; 92%) used the interactive decision aid intensively. On average, patients spent almost 70min searching for information and selected 21 information topics. Overall, treatment related information was clearly more selected than other types of information. Age, education, and decision style factors were associated with information selection. CONCLUSION The interactive breast cancer decision aid was utilized intensively. The interactive system was found to facilitate that different patients received different amounts and types of information. PRACTICE IMPLICATIONS Interactive decision aids may improve information giving to patients, and as a result, the quality of care. To safeguard informed-choice, decision aids should be used in conjunction with other communication strategies. Decision aids should be available continuously and throughout the patients' disease journey. The Internet may help to achieve broad dissemination and enduring access.
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Affiliation(s)
- Sjaak Molenaar
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology (Room J3-401), P.O. Box 22 660, 1100 DD Amsterdam, The Netherlands.
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Dian D, Schwenn K, Mylonas I, Janni W, Friese K, Jaenicke F. Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. J Cancer Res Clin Oncol 2006; 133:247-52. [PMID: 17096124 DOI: 10.1007/s00432-006-0163-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 09/28/2006] [Indexed: 12/01/2022]
Abstract
PURPOSE Besides the quality of the aesthetic results, the quality of life after surgery is one of the most important criteria when reviewing different operation methods, especially in oncologic diseases. This study was performed to evaluate the difference in the health-related quality of life following breast conserving surgery and autologous breast reconstruction after mastectomy. PATIENTS AND METHODS Hundred and forty-four breast cancer patients were included in this study. Sixty seven patients underwent breast conserving surgery followed by radiotherapy. In 77 patients a mastectomy was performed with immediate or late reconstruction. To evaluate the health-related quality of life we used the SF-36 self-administered questionnaire. RESULTS A significant difference was found in quality of life in the subscale "physical functioning" showing better results in the breast reconstruction group (P = 0.01). No significant difference was found in the other subscales, but there was a tendency to a better "emotional role" among the breast reconstruction patients. CONCLUSION Our study demonstrated that autologous tissue breast reconstruction in breast cancer patients did not affect adversely the health-related quality of life compared to breast conserving therapy when the quality of life is assessed by the standardized questionnaire SF-36. In particular, the physical function is not reported to be significantly influenced negatively by the more extensive surgical therapy.
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Affiliation(s)
- D Dian
- University Hospital Munich, Munich, Germany.
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Abstract
BACKGROUND : Reliable and valid assessment instruments in aesthetic surgery are a vital factor in assessing patient satisfaction with physical appearance. Appearance and satisfaction assessments are needed to adequately evaluate quality of life related to changes in the female breast across a variety of surgical interventions. The Breast Evaluation Questionnaire was designed to assess satisfaction with breast attributes. METHODS : The Breast Evaluation Questionnaire is a 55-item assessment that was validated on 1244 women seeking augmentation mammaplasty. RESULTS : Subscales of the Breast Evaluation Questionnaire include comfort not fully dressed, comfort fully dressed, and satisfaction with breast attributes. The questionnaire has been demonstrated to be valid and reliable for assessing these factors. CONCLUSIONS : The assessment is easy to administer and interpret and is recommended for assessing outcomes among breast augmentation patients, breast reconstruction patients, mastectomy patients, lumpectomy/breast-sparing surgery patients, breast reduction patients, and patients who have sustained trauma or injury to their breasts.
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Arenas M, Sabater S, Hernández V, Henríquez I, Ameijide A, Anglada L, Mur E, Artigues M, Lafuerza A, Borras J. Cosmetic outcome of breast conservative treatment for early stage breast cancer. Clin Transl Oncol 2006; 8:334-8. [PMID: 16760008 DOI: 10.1007/s12094-006-0179-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the cosmetic outcome of breast conservative therapy and to examine the degree of agreement between the patients' and oncologists' ratings. We also analyze the influence of several factors on cosmesis. METHODS AND MATERIALS We retrospectively evaluated 145 patients with primary breast cancer treated by local excision and radiotherapy between January 2000 and May 2001. Cosmetic outcome was evaluated by doctors and patients and was scored as excellent, good, fair or poor. RESULTS 73% of patients rated cosmesis as excellent or good while the percentage was 71% when rated by radiation oncologists. The degree of cosmesis concordance evaluated by oncologists and patients was low (kappa = 0.3). In our study the variables which significantly influence on the cosmetic outcome were concomitant adjuvant chemotherapy (p = 0.04) and radiation therapy boost, either by electron beam or brachytherapy (p = 0.013). CONCLUSION The cosmetic outcome of breast conserving therapy was good. There was a similar rating by the patient and radiation oncologist, but the level of concordance between patients and doctors was low. Factors that significantly influence the cosmesis appear to be concomitant adjuvant chemotherapy and radiation therapy boost.
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Affiliation(s)
- M Arenas
- Oncology Department, Hospital Universitari Sant Joan de Reus, Catalonia, Spain.
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Martin MA, Meyricke R, O'Neill T, Roberts S. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer--a classification tree approach. BMC Cancer 2006; 6:98. [PMID: 16623956 PMCID: PMC1459180 DOI: 10.1186/1471-2407-6-98] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 04/20/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A critical choice facing breast cancer patients is which surgical treatment--mastectomy or breast conserving surgery (BCS)--is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of "propensity" is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. METHODS Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. RESULTS Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. CONCLUSION Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients.
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Affiliation(s)
- Michael A Martin
- School of Finance and Applied Statistics, Australian National University, Canberra ACT, 0200, Australia
| | - Ramona Meyricke
- School of Finance and Applied Statistics, Australian National University, Canberra ACT, 0200, Australia
| | - Terry O'Neill
- School of Finance and Applied Statistics, Australian National University, Canberra ACT, 0200, Australia
| | - Steven Roberts
- School of Finance and Applied Statistics, Australian National University, Canberra ACT, 0200, Australia
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Fehlauer F, Tribius S, Mehnert A, Rades D. Health-related quality of life in long term breast cancer survivors treated with breast conserving therapy: impact of age at therapy. Breast Cancer Res Treat 2006; 92:217-22. [PMID: 16155792 DOI: 10.1007/s10549-005-2420-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Aim was to compare the functional status in long-term breast cancer survivors related to age at diagnosis and to asses the effects of adjuvant therapy on health-related quality of life (HRQoL). PATIENTS AND METHODS Data were obtained from 370 patients after breast conserving therapy (BCT) at follow-up (F/U) visit. The self-administered EORTC QoL questionnaire (C30) and the breast module (QLQ-BR23) measuring global health, global QoL, physical, role, emotional, cognitive and social functioning, body image, sexual function, future perspective and arm/breast symptoms were used. Patients were grouped according to F/U (12 years, 7 years), age at therapy (< 50 years, 50-65 years, >65 years) and adjuvant treatment (none, chemotherapy, hormone replacement therapy). RESULTS The global HRQoL was increased in patients with longer F/U (p < 0.01). Physical functioning, role functioning and sexual functioning were decreased in patients being older at therapy (> 65 years, p < 0.01). Increased arm symptoms were noticed in older women at longer follow-up. Younger women at therapy complained financial difficulties at follow-up (p < 0.006). Adjuvant chemotherapy and hormone replacement therapy did not affect physical and mental functioning. CONCLUSION Women of different age treated with BCT for breast cancer should be considered at a different risk for HRQoL disturbance at long term F/U in both, physical and psychological dimensions. In clinical practice, specific identification of those women with negative impact of diagnosis and treatment on long term HRQoL would help for targeted interventions. In clinical studies focusing on HRQoL, the compared groups need to be age-adjusted.
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Affiliation(s)
- Fabian Fehlauer
- Department of Radiation Oncology, University Clinic Hamburg-Eppendorf, Germany.
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Abstract
BACKGROUND AND AIMS The aim of this study is to evaluate the demand for plastic operations after primary breast cancer surgery. In addition, this study aims to increase knowledge on factors affecting the wish of women for breast reconstruction. MATERIAL AND METHODS A questionnaire was sent to some 111 patients who had undergone either mastectomy or breast conserving surgery. The response rate was 76%. The questionnaire consisted of 20 structured questions. The data was analysed statistically using the t test and the chi-square test. RESULTS 28% of the mastectomized patients wanted a breast reconstruction. Factors found to affect the patient's wish for reconstruction were age (p < 0.001) and whether the patient had received radio- (p < 0.05) or chemotherapy (p < 0.05). A difference was found between the mastectomy group and the breast conserving surgery group as to satisfaction in the general (p < 0.05) and the cosmetic (p < 0.05) outcome of the surgery, as well as patient's expectations regarding the outcome (p < 0.01). CONCLUSIONS Rather fewer mastectomized patients wanted a reconstruction. The proportion, however, grew significantly larger in the younger age groups. This study also shows that receiving radio- or chemotherapy seems to predict a woman's choice against a reconstruction. Patients who receive radio- or chemotherapy may consider their illness more severe and life-threatening than those not receiving such treatments.
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Affiliation(s)
- T Meretoja
- Department of Plastic and Reconstructive Surgery, Turku University Hospital, Turku, Finland.
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Monteiro-Grillo I, Marques-Vidal P, Jorge M. Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer. Clin Transl Oncol 2005; 7:499-503. [PMID: 16373061 DOI: 10.1007/bf02717003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the quality-of-life (QoL) and psychosocial changes in a group of patients with early breast cancer who underwent conservative surgery (BCS) or modified radical mastectomy(MRM). METHODS Self-administered questionnaire assessing body image perception, social habits, sexual attraction and self-consciousness with relatives/friends, was randomly assigned to 125 patients (61 BCS, 64 MRM; aged 53 +/- 8 and 50 + 9 years, respectively, p = NS). RESULTS MRM patients reported a significantly higher frequency of changes in body image perception and other related social behaviour such as avoiding going to the beach or using low-cut clothes, and reticence with friends. Conversely, no differences were found regarding sexuality, denial of the disease by the husband/partner, or concealing the disease from family members. Also, no significant differences were found between patients above and below the age of 50 years, for all variables studied after adjustment for surgical procedure. CONCLUSIONS Modified radical mastectomy has a negative effect on body image perception and in social behaviour patterns of patients and with a concomitant decrease in QoL. The sexuality of the patient is not significantly affected.
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Affiliation(s)
- Isabel Monteiro-Grillo
- Serviço de Radioterapia, Hospital de Santa Maria, Centro de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal.
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Abstract
BACKGROUND Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction. METHODS A chart analysis was conducted of all patients who underwent Breast Cancer Reconstruction at the Royal Adelaide Hospital Breast Unit between 1990 and 2002. Patients were then traced and asked to take part in an interview. Mastectomy and breast conservation patients who attended outpatient clinic for follow up were also approached. All three groups were interviewed and self-assessment quality of life questionnaires (Functional Assessment of Cancer Therapy-Breast, body image) were administered. The breast conservation and reconstruction groups also underwent assessment of satisfaction and cosmesis. RESULTS A total of 78 mastectomy, 109 breast conservation and 123 breast reconstruction patients were interviewed. Quality of life assessment was similar between the three groups but the breast conservation and reconstruction patients' body image scores were superior to the mastectomy group. Patient satisfaction was higher in the reconstruction group than the breast conservation group of patients, while cosmesis was similar. CONCLUSION While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.
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Affiliation(s)
- Maria Teresa Nano
- Adelaide University, Division of Medicine, Department of Surgery, South Australia, Australia.
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48
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Affiliation(s)
- Nananda F Col
- Department of Medicine, Brown Medical School and Rhode Island Hospital, MPB-1, 593 Eddy St., Providence, Rhode Island 02903, USA
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Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Lakhani I, Salem B, Katz SJ. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res 2005; 40:745-67. [PMID: 15960689 PMCID: PMC1361166 DOI: 10.1111/j.1475-6773.2005.00383.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To better understand medical decision making in the context of "preference sensitive care," we investigated factors associated with breast cancer patients' satisfaction with the type of surgery received and with the decision process. DATA SOURCES/DATA COLLECTION For a population-based sample of recently diagnosed breast cancer patients in the Detroit and Los Angeles metropolitan areas (N=1,633), demographic and clinical data were obtained from the Surveillance, Epidemiology, and End Results tumor registry, and self-reported psychosocial and satisfaction data were obtained through a mailed survey (78.4 percent response rate). STUDY DESIGN Cross-sectional design in which multivariable logistic regression was used to identify sociodemographic and clinical factors associated with three satisfaction measures: low satisfaction with surgery type, low satisfaction with the decision process, and decision regret. PRINCIPAL FINDINGS Overall, there were high levels of satisfaction with both surgery and the decision process, and low rates of decision regret. Ethnic minority women and those with low incomes were more likely to have low satisfaction or decision regret. In addition, the match between patient preferences regarding decision involvement and their actual level of involvement was a strong indicator of satisfaction and decision regret/ambivalence. While having less involvement than preferred was a significant indicator of low satisfaction and regret, having more involvement than preferred was also a risk factor. Women who received mastectomy without reconstruction were more likely to report low satisfaction with surgery (odds ratio [OR]=1.54, p<.05), low satisfaction with the process (OR=1.37, p<.05), and decision regret (OR=1.55, p<.05) compared with those receiving breast conserving surgery (BCS). An additional finding was that as patients' level of involvement in the decision process increased, the rate of mastectomy also increased (p<.001). CONCLUSIONS A significant proportion of breast cancer patients experience a decision process that matches their preferences for participation, and report satisfaction with both the process and the outcome. However, women who report more involvement in the decision process are significantly less likely to receive a lumpectomy. Thus, increasing patient involvement in the decision process will not necessarily increase use of BCS or lead to greater satisfaction. The most salient aspect for satisfaction with the decision making process is the match between patients' preferences and experiences regarding participation.
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Affiliation(s)
- Paula M Lantz
- 109 Observatory, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, 48109-2029, USA
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Abstract
A high level of anticipatory distress in women scheduled for surgery to detect or treat breast cancer emphasizes the importance of investigation of potential targets for distress-reducing interventions. Exercise and sleep have been examined in relation to distress in this population, focusing on the postsurgery period. In this study the authors examined the contributions of physical activity and sleep to anticipatory distress levels in 124 women prior to breast surgery. Patients completed measures of distress, activity and sleep. The authors hypothesized that higher levels of activity and better sleep would be associated with lower anticipatory distress. Additionally, the authors hypothesized that the effects of physical activity on distress would be accounted for by (mediated) sleep quality. Results indicated that physical activity and sleep quality were negatively related to distress (p < .05); however, activity effects were not mediated by sleep. These findings have implications for designing interventions to reduce anticipatory breast surgery distress.
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Affiliation(s)
- Kristin Tatrow
- Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, USA.
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