Mastectomy versus conservative surgical treatment: the impact on the quality of life of women with breast cancer

Abstract

OBJECTIVES: to compare the impact of mastectomy and conservative surgery on the quality of life of patients with breast cancer. METHODS: an assessment was made of the quality of life of patients undergoing mastectomy or segmentary mastectomy, at the Pouso Alegre Clinical Hospital, in the Brazilian State of Minas Gerais, using SF-36. The patients were grouped by age (<50 years and >50 years) and years of schooling (<8 years and >8 years). The Mann-Whitney test was used to compare the groups with regard to the age and schooling domains of SF-36. RESULTS: a significant difference between the two groups was found in the domains of "physical functioning" (p=0.04) and "pain" (p=0.01): with the patients undergoing a mastectomy registering the worst scores. Young patients who had undergone a mastectomy displayed the worst quality of life in terms of "physical functioning" (p=0.03), "pain" (p=0.01) and "social functioning" (p=0.01); those undergoing conservative surgery aged over 50 years scored worst on "role emotional" (p=0.05). Patients undergoing a mastectomy with lower levels of schooling scored lower in "physical functioning" (p=0.01), "role physical" (p=0.05) and "pain" (p=0.05). Among those who had attended school for more than eight years, those having undergone a mastectomy scored less in the "pain" domain (p=0.04). CONCLUSIONS: patients who had undergone a mastectomy had worse results in the physical component of the evaluation of quality of life and this negative impact was more strongly felt among younger patients and those with lower levels of schooling.

Characterization of pain in women after breast cancer treatment

“…The chronic pain which appears after surgery is explained as the result of the injury to structures such as muscles and ligaments -and as neuropathic, when it affects nerves or is a dysfunction of the nervous system 6,8 . Therefore, when one evaluates the impact that these operations can have on the patients' quality of life, it is evidenced that the mastectomy can result in a lower score for quality of life, as the pain which can be caused by the surgery can lead to functional compromise 11 . 3 sought the characteristics of the pain, they identified that the women who undertake treatment for breast cancer report the pain as intermittent and constant.…”

“…Knowledge about the pain relief measures is extremely important for the teams who work with these women 4,18 . Appropriate pain management must be implemented, avoiding self-treatment, since this can further compromise the symptom of pain in women with breast cancer 11,13 . …”

Quality of life of women with pre-and post-operative breast cancer

“…18 They are the women of less social classes, numbers that remain on the rise, evidencing a process of feminization of poverty. In Brazil, many families are headed by women and the most of them live in the metropolitan areas.…”

“…A similar study found that women who perform total mastectomy when compared to those who undergo Segmented mastectomy have a worse evaluation in this dimension. 18 In Nepal, women with breast cancer had good results in the Physical Functioning dimension, especially women with higher education level. In the Sexual Function and Sexual Pleasure, QOL losses were higher.…”

Perceptions, feelings and physical and emotional experiences of woman after breast cancer

“…However, this step is important so there is value and improvement of quality of life and the self care, as discussed by some authors 5,6,23 . Being so, questions referring the shoulder functionality, to the impossibility to re-take the labor activity and the branch of acceptance of her mutilated body, propels reflective actions surrounding esthetic concepts (as shaving of the affected area and lymphedema) and new life styles (obstacles or physical restrictions).…”