Longitudinal Study of Psychosocial Outcomes Following Surgery in Women with Unilateral Nonhereditary Breast Cancer.

Abstract

INTRODUCTION:

Rates of bilateral mastectomy are rising in women with unilateral, nonhereditary breast cancer. We aim to characterize how psychosocial outcomes evolve after breast cancer surgery.

PATIENTS AND METHODS:

We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network in Toronto, Canada between 2014 and 2017. Women completed validated psychosocial questionnaires (BREAST-Q, Impact of Event Scale, Hospital Anxiety & Depression Scale) preoperatively, and at 6 and 12 months following surgery. Change in psychosocial scores was assessed between surgical groups using linear mixed models, controlling for age, stage, and adjuvant treatments. P < .05 were significant.

RESULTS:

A total of 475 women underwent unilateral lumpectomy (42.5%), unilateral mastectomy (38.3%), and bilateral mastectomy (19.2%). There was a significant interaction (P < .0001) between procedure and time for breast satisfaction, psychosocial and physical well-being. Women having unilateral lumpectomy had higher breast satisfaction and psychosocial well-being scores at 6 and 12 months after surgery compared with either unilateral or bilateral mastectomy, with no difference between the latter two groups. Physical well-being declined in all groups over time; scores were not better in women having bilateral mastectomy. While sexual well-being scores remained stable in the unilateral lumpectomy group, scores declined similarly in both unilateral and bilateral mastectomy groups over time. Cancer-related distress, anxiety, and depression scores declined significantly after surgery, regardless of surgical procedure (P < .001).

CONCLUSIONS:

Psychosocial outcomes are not improved with contralateral prophylactic mastectomy in women with unilateral breast cancer. Our data may inform women considering contralateral prophylactic mastectomy.

• Authors: David W Lim, Helene Retrouvey, Isabel Kerrebijn, Kate Butler, Anne C O'Neill, Tulin D Cil, Toni Zhong, Stefan O P Hofer, David R McCready, Kelly A Metcalfe
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 28 Issue 11 Pg. 5985-5998 (Oct 2021) ISSN: 1534-4681 [Electronic] United States
• PMID: 33821345 (Publication Type: Journal Article)
• Copyright: © 2021. Society of Surgical Oncology.

Topics

• Breast Neoplasms (surgery)
• Female
• Humans
• Longitudinal Studies
• Mammaplasty
• Mastectomy
• Prospective Studies
• Unilateral Breast Neoplasms