Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

Abstract

in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image. EJSO -European Journal of Surgical Oncology, WB Saunders, 2010, 36 (8) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. To investigate and compare long-term health-related quality of life (HRQoL), body image, and emotional reactions in women with ductal carcinoma in situ of the breast (DCIS) treated with different surgical methods. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Patients and Methods:A total of 162 women were included in the study (47 had mastectomy and immediate breast reconstruction (IBR), 51sector resection alone and 64 sector resection and postoperative radiotherapy). All women included in the study were asked to complete three questionnaires 4-15 years after surgery: the SF-36 for HRQoL, the Hospital Anxiety and Depression (HAD) scale, and the Body Image Scale (BIS). The response rate was 81%. Results:Women in all three study groups had, overall, a very satisfactory HRQoL in the long term, similar to women in the general population. Women who underwent mastectomy and IBR scored significantly higher on physical functioning and bodily pain than the other two study groups as well as their age-adjusted norm groups. The addition of radiotherapy to breast-conserving therapy did not seem to have any negative impact on long-term HRQoL. Our results show significant differences between the three study groups for six of ten BIS items, with a greater proportion of women in the mastectomy and IBR group reporting problems. Conclusions:Women treated for DCIS have a very satisfactory long-term HRQoL. However, body image appeared to be negatively affected in mastectomy and IBR patients. Our results indicate that these women need more preoperative information about what changes in body image to expect after surgery.

Self-perceived, but not objective lymphoedema is associated with decreased long-term health-related quality of life after breast cancer surgery

“…26 In a Swedish study, women treated with mastectomy and primary reconstruction for in situ breast cancer, reported less bodily pain than their age-adjusted norm-group. 27 Women undergoing ALND had significantly greater risk of reporting self-perceived arm lymphoedema than women who underwent SLNB alone. However, when defining arm lymphoedema as !10% increase in arm volume difference; there was no statistically significant agreement between self-perceived arm lymphoedema and objectively measured arm lymphoedema one and three years after surgery.…”

Patient age is related to decision-making, treatment selection, and perceived quality of life in breast cancer survivors

“…Poorer body image in young breast cancer survivors may reflect increased selection of mastectomy as a treatment option [29]. Concerns for appearance have led younger patients to opt for lumpectomy more frequently compared to their older counterparts [30].…”

Body image investment in breast cancer patients undergoing reconstruction: Taking a closer look at the Appearance Schemas Inventory-Revised

“…Although breast reconstruction has been shown to have positive benefits for women’s social and psychological well-being (Cordeiro, 2008), many women receiving reconstruction are found to endorse body image difficulties that can persist even years post treatment (Sackey, Sandelin, Frisell, Wickman, & Brandberg, 2010). Considerable research is devoted to comparing body image and quality of life outcomes for women undergoing breast conservation therapy (BCT), mastectomy alone, or mastectomy with reconstruction.…”

“…Considerable research is devoted to comparing body image and quality of life outcomes for women undergoing breast conservation therapy (BCT), mastectomy alone, or mastectomy with reconstruction. Studies report conflicting findings; however, higher rates of body image concerns have been repeatedly found among patients treated with mastectomy and reconstruction compared to BCT (Fobair et al, 2006; Rosenberg et al, 2012; Sackey et al, 2010; Shoma et al, 2009). A recent meta-analysis by Fang and colleagues offers further insight in this area showing that women with breast reconstruction experience significantly higher levels of body stigma compared to women treated with BCT (Fang, Shu, & Chang, 2013).…”