Contralateral prophylactic mastectomy for unilateral breast cancer in women at average risk: Systematic review of patient reported outcomes

Abstract

Objective The rate of contralateral prophylactic mastectomy (CPM) in women with early, unilateral cancer is relatively high and is increasing around the world a previous study. Women choose this option for many reasons other than reducing their risk of future cancer, including symmetry, reasons related to breast reconstruction and attempting to manage fear of recurrence. This systematic review evaluated patient‐reported quality of life outcomes following CPM. Methods A literature search of MEDLINE, PubMed and PsycINFO was performed to February 2019. Abstracts and full‐text articles were assessed for eligibility according to pre‐determined criteria. Data were extracted into evidence tables for analysis. Results A total of 19 articles met eligibility criteria and were included in analysis. These included patient‐reported data from 6088 women undergoing CPM. They reported high levels of satisfaction with the decision for surgery, low levels of decisional regret and high satisfaction with cosmesis and reconstruction. Breast‐specific and general quality of life was high overall but was even better in women choosing breast reconstruction after surgery. Fear of cancer recurrence was high after CPM. Depression, distress and a negative impact on body image were evident; however, levels were high in both CPM and non‐CPM groups. Conclusions This study provides information that can be used by surgeons and psychologists when counselling women about the potential benefits and harms of CPM. This process must include discussion about the trade‐offs such as body image issues and ongoing fear of recurrence in addition to the positive aspect of cancer risk reduction. Women are unlikely to regret their decision for CPM.

Peace of Mind: A Role in Unnecessary Care?

“…Conversely, other studies have shown that breast-related quality of life remained high among both CPM patients and those who did not undergo CPM. 34 These mixed results suggest that treatment decision making remains a very patient-centered and patient-specific outcome.…”

A concept analysis of decision regret in women with breast cancer

“…“Outcome regret” occurs when a suboptimal, unfavorable, or an unanticipated outcome arises from the decision. The most prevalent outcome antecedents precipitating outcome regret include cancer recurrence, 9,33 dissatisfaction toward expected outcomes, 7,9,11,21,34,35,37,38 surgical complications, 35,37,38 a negative body image, 21,33,35 or the occurrence of lower sexual well‐being 11,21,35,38 …”

“…Even with the best intentions, clinicians can fall short in ensuring each step of the decision‐making process is adequate for informed decision‐making. “Process regret” is associated with decisions made in relation to the decision‐making process and can be attributed to (a) decisions made during time constraints due to the urgency of breast cancer treatment, 10,26,34,40 (b) poor communication or inadequate information on options, risks, and expected outcomes, 7,20,21,26,31,33,35,37,38,40–42 and (c) malalignment between the decision made and the patient's decision preference 26,37,41,43 …”

“…The current literature on decision regret in women making breast cancer treatment decisions has shown decision regret to be predictive of reduced quality of life 20,26,30,35 . Decision regret also leads to short‐ and long‐term psychological distress 9,24,30,35,38 …”

Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol

“…However, they did not specifically address the issue of regret about treatment decisions, and were not able to generalise to the whole population because these reviews only included older women22 and women who had a mastectomy 23. Previous reviews on decision regret related to breast reconstruction24 and risk-reducing treatment25 26 also could not provide a holistic understanding of decision regret regarding EBC treatments because other treatments, such as BCS, chemotherapy and radiotherapy, are also common choices for EBC. To date, there is a lack of literature synthesis regarding levels of decision regret, what patients regret, and factors associated with decision regret regarding breast cancer treatments among women with EBC.…”