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Ayub F, Khan TM, Baig MR, Amin MU, Tahir H. Quality of life and wellbeing among breast cancer patients in Lahore, Pakistan. Front Oncol 2023; 13:1105411. [PMID: 37456255 PMCID: PMC10341154 DOI: 10.3389/fonc.2023.1105411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Background Breast cancer has a high incidence rate, emphasizing the necessity of enhanced information on health-related quality of life (HrQOL) in this population of patients. The aim of this study was to identify the factors influencing the QOL experienced by patients in Pakistan. Methods A cross-sectional study was conducted on women with breast cancer, and four instruments were used on a random sample of 130 Pakistani women: FACIT-B Version 4 questionnaire,WHO causality assessment scale, Naranjo's algorithm, and a demographic/clinical characteristics section. Data analysis included descriptive analysis, independent sample t-test, and analysis of variance (ANOVA) test. Results The patients' mean age was 49.10 (standard deviation (SD) 10.89); 98.5% were married. The mean score was 18.34 for physical wellbeing (SD 5.92; interquartile range (IQR) 11), 16.33 for social/family wellbeing (SD 6.3; IQR 11.25), 13.6 for emotional wellbeing (SD 3.55; IQR 6), 17.13 for functional wellbeing (SD 3.73; IQR 6), and 24.86 for breast cancer subscale (SD 3.64; IQR 4). The study found that the age, entitlement, recurrence, marital status, salary, number of doses, duration of cancer treatment, and chemotherapy sessions were significantly related to QOL terms in the assessment of the FACIT-B scale. The WHO causality evaluation scale determined that 78.1% of the responses were "probable" and 20.1% were "possible". According to Naranjo's algorithm assessment scale, 80% of adverse drug reactions (ADRs) were "probable", whereas 18.4% were declared "possible". Chemotherapy-induced anemia was the most often reported ADR in 64.6% of patients, followed by chemotherapy-induced nausea and vomiting (61.5%). Conclusion Healthcare practitioners must acknowledge and take into account the significance of QOL in addition to therapy for breast cancer patients in order to enhance their health. The findings of this study will aid in filling gaps in current unknown knowledge and identifying sites where patients require additional assistance. Because cancer and chemotherapy clearly have a negative impact on individuals' QOL, oncologists must concentrate on strategies that help cancer patients during their sickness and treatment while also enhancing self-care and QOL. Those with cancer will benefit from emotional wellbeing and adaptation to their disease.
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Affiliation(s)
- Fiza Ayub
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science UVAS, Lahore, Pakistan
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science UVAS, Lahore, Pakistan
| | - Mirza Rafi Baig
- Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | | | - Humera Tahir
- Ruth Pfau College of Nutrition Sciences, Lahore Medical and Dental College, Lahore, Pakistan
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Weick L, Ericson A, Sandman L, Boström P, Hansson E. Patient experience of implant loss after immediate breast reconstruction: An interpretative phenomenological analysis. Health Care Women Int 2023; 44:61-79. [PMID: 34427538 DOI: 10.1080/07399332.2021.1944152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immediate breast reconstruction (IBR) is an integral part of modern breast cancer treatment. Our aim was to investigate patient experience with implant loss after IBR by using interpretative phenomenological analysis (IPA). We conducted semi-structured interviews with eight informants. We analyzed data according to the IPA flexible seven-stage process and four main themes were developed: immediate breast reconstruction as the indisputable choice, a difficult experience, an altered body: redefining normality, and trying to cope. The experience of implant loss appears to affect women for many years and might overshadow some of the benefits of IBR.
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Affiliation(s)
- Linn Weick
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alice Ericson
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Västra Götaland Region, Gothenburg, Sweden.,Faculty of Police Work, department of Campus Police Education, Borås University, Borås, Sweden
| | - Petra Boström
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Sciences, Gothenburg University, Gothenburg, Sweden
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Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2022; 9:2323-2333. [PMID: 34647274 DOI: 10.1007/s40615-021-01169-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. METHODS Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. RESULTS African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. CONCLUSIONS We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.
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Breast Cancer, Planarians, and Plastic Surgeons. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4080. [PMID: 35169518 PMCID: PMC8835616 DOI: 10.1097/gox.0000000000004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
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"Struggling to Accept the New Breast as Part of My Body" - The Challenge of Immediate Breast Reconstruction in Women With Breast Cancer. Cancer Nurs 2022; 45:262-270. [PMID: 35025772 DOI: 10.1097/ncc.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Women have difficulties in making decisions and experiences an unexpectedly long recovery period after immediate breast reconstruction. There are still many limitations in understanding the overall changes in life experienced by women with breast cancer before and after immediate breast reconstruction. OBJECTIVE This study aimed to explore the challenges experienced by women with breast cancer undergoing immediate breast reconstruction and how they coped with these problems. METHODS Strauss and Corbin's grounded theory design was used. In-depth face-to-face individual interviews were undertaken with 11 women with breast cancer from 4 hospitals in Korea. Data collection and analysis were conducted simultaneously, using the constant comparative method. RESULTS The core category was "struggling to accept the new breast as part of my body." "Decision making regarding immediate breast reconstruction" was the initial step, followed by "facing the changed breasts after surgery." The challenge of "living with the new breasts" slowly merged into "making up my mind to accept my breasts with gratitude." CONCLUSION Women with breast cancer undergoing immediate breast reconstruction struggled to accept the new breast as part of their body, and some reached a measure of closure and acceptance with gratitude. IMPLICATION FOR PRACTICE Nurses can apply findings by recognizing the experiences, perceptions, and needs of women; providing patients with sufficient information on the whole process; and offering continuous supportive care to facilitate the coping process. In addition, nurses should consider a variety of approaches that help women to integrate their changed bodies into their self-concept and self-image and restore a sense of normality.
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Weick L, Brorson F, Jepsen C, Lidén M, Jensen EW, Hansson E. Giving meaning to patient reported outcomes in breast reconstruction after mastectomy - A systematic review of available scores and suggestions for further research. Breast 2021; 61:91-97. [PMID: 34929423 PMCID: PMC8693348 DOI: 10.1016/j.breast.2021.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background There are three patient reported outcome measure instruments (PROMs) that have adequate content validity for breast reconstruction, BREAST-Q, BRECON-31 and EORTC QLQ-BRECON-23, and they all have been robustly validated. The aim of this study was to systematically review scores giving meaning to validated PROMs for breast reconstruction after mastectomy and discuss methods to enable interpretation of them. Methods A systematic review was performed according to the recommendations of PRISMA. Prospero CRD42021255874. Included articles had to meet criteria defined in a SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). The included studies were critically appraised using the GRADE approach. Results Three articles were finally included in the review: two studies on scores for healthy controls and one on minimally important differences (MIDs), both of BREAST-Q. All of the studies were performed in North America. Only MIDs based on statistical characteristics, and not on what constitutes a relevant change for the patient, exist. The risk of bias was evaluated as very high and moderate, respectively, of inconsistencies as low, of indirectness as high, of imprecisions as low, and of publication bias as probably low. Conclusions The overall certainty of evidence for scores giving meaning to PROMs for breast reconstruction is low (GRADE ƟƟОО). More studies are needed to establish relevant healthy control scores and what constitutes a relevant clinical difference for patient-reported outcome measures for breast reconstruction after mastectomy. Clinical implications of the findings and suggestions for further research are suggested in the article. Patient reported outcome measurements have to be clinically interpretable to make sense. Three articles on scores giving meaning to PROMs for breast reconstruction post-mastectomy exist. More studies are needed to establish relevant controls and clinical differences in scores. Clinical implications and suggestions for further research are discussed.
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Affiliation(s)
- Linn Weick
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Fredrik Brorson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Christian Jepsen
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Emmelie Widmark Jensen
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
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Johnson L, Holcombe C, O'Donoghue JM, Jeevan R, Browne J, Fairbrother P, MacKenzie M, Gulliver-Clarke C, White P, Mohiuddin S, Hollingworth W, Potter S. Protocol for a national cohort study to explore the long-term clinical and patient-reported outcomes and cost-effectiveness of implant-based and autologous breast reconstruction after mastectomy for breast cancer: the brighter study. BMJ Open 2021; 11:e054055. [PMID: 34408062 PMCID: PMC8375757 DOI: 10.1136/bmjopen-2021-054055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Breast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the long-term outcomes of different BR procedures is essential to support informed decision-making. As different techniques vary considerably in cost, policymakers also require high-quality cost-effectiveness evidence to inform care. The Brighter study aims to explore the long-term clinical and patient-reported outcomes (PROs) of implant-based and autologous BR and use health economic modelling to compare the long-term cost-effectiveness of different reconstructive techniques. METHODS AND ANALYSIS Women undergoing mastectomy and/or BR following a diagnosis of breast cancer between 1 January 2008 and 31 March 2009 will be identified from hospital episode statistics (HES). Surviving women will be contacted and invited to complete validated PRO measures including the BREAST-Q, EQ-5D-5L and ICECAP-A, or opt out of having their data included in the HES analysis. Long-term clinical outcomes will be explored using HES data. The primary outcome will be rates of revisional surgery between implant-based and autologous procedures. Secondary outcomes will include rates of secondary reconstruction and reconstruction failure. The long-term PROs of implant-based and autologous reconstruction will be compared using BREAST-Q, EQ-5D-5L and ICECAP-A scores. Multivariable regression will be used to examine the relationship between long-term outcomes, patient comorbidities, sociodemographic and treatment factors. A Markov model will be developed using HES and PRO data and published literature to compare the relative long-term cost-effectiveness of implant-based and autologous BR. ETHICS AND DISSEMINATION The Brighter study has been approved by the South-West -Central Bristol Research Ethics Committee (20/SW/0020), and the Confidentiality Advisory Group (20/CAG/0021). Results will be published in peer-reviewed journals and presented at national meetings. We will work with the professional associations, charities and patient groups to disseminate the results.
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Affiliation(s)
- Leigh Johnson
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Joe M O'Donoghue
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ranjeet Jeevan
- Manchester University NHS Foundation Trust, Manchester, UK
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | | | | | | | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | - Syed Mohiuddin
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | - Shelley Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Validation and reliability testing of the Breast-Q latissimus dorsi questionnaire: cross-cultural adaptation and psychometric properties in a Swedish population. Health Qual Life Outcomes 2021; 19:174. [PMID: 34217326 PMCID: PMC8254980 DOI: 10.1186/s12955-021-01812-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background The main aim of post-mastectomy breast reconstruction is to improve the patient’s quality of life, which makes high-quality and validated patient-reported outcome measurements essential. None of the established instruments include evaluation of donor-site morbidity, such as impact on upper extremity and back function, when a latissimus dorsi (LD) muscle is used; and BREAST-Q LD questionnaire was therefore recently developed for this purpose. The aim of this study was to translate into Swedish and culturally adapt the BREAST-Q LD questionnaire’s two subscales, appearance and function, and perform a psychometric evaluation of the subscales in a Swedish population of patients. Methods This was a cross-sectional study. The questionnaire was translated according to established guidelines. The questionnaires were sent to all patients operated using an LD flap between 2007 and 2017. Internal consistency was assessed using Cronbach’s α. Inter-item correlations and corrected item-total correlations were calculated using the Pearson’s correlation coefficient. Convergent validity was evaluated by comparing the BREAST-Q LD questionnaire to the Western Ontario Osteoarthritis of the Shoulder Index, using the Spearman correlation coefficient. Test–retest reliability was tested with intraclass correlation coefficients (ICCs), and the coefficient of variation and Bland–Altman plots were drawn. Floor and ceiling effects were calculated. Known-group validation was tested by comparing scores from the patients and from normal controls using the Mann–Whitney U-test and by calculating eta squared effect size. Results The questionnaires were sent to 176 eligible patients and 125 responded (71%). The patients had been operated a mean of 6.6 years ago, and most (92%) had previous radiation. Internal consistency was satisfactory for both subscales. The correlation coefficients between questions were r > 0.30 for all items of both scales. The corrected item-total correlation coefficient ranged from 0.62 to 0.90. As hypothesised, the function scale was correlated with the WOOS “Physical symptoms” subscale. Reliability was adequate according to the ICCs. The ceiling effect threshold for the appearance scale was reached and that for the back scale was almost reached. There were significant differences between patients and controls, in the hypothesised direction. Conclusions The results of this study support a good internal consistency, convergent validity, test–retest reliability and known-group validation for the Swedish BREAST-Q LD questionnaire. However, it may be difficult to discriminate between patients with very mild and those with no symptoms using the appearance scale. Trial registration: ClinicalTrials.Gov identifier NCT04526561.
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Gandhi A, Duxbury P, Murphy J, Foden P, Lalloo F, Clancy T, Wisely J, Kirwan CC, Howell A, Evans DG. Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:69-76. [PMID: 34219040 DOI: 10.1016/j.bjps.2021.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/12/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
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Affiliation(s)
- A Gandhi
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Duxbury
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - J Murphy
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - P Foden
- Department of Medical Statistics, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - F Lalloo
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - T Clancy
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Wisely
- Department of Clinical Psychology, Laureate House, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - C C Kirwan
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Howell
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D G Evans
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Everaars KE, Welbie M, Hummelink S, Tjin EPM, de Laat EH, Ulrich DJO. The impact of scars on health-related quality of life after breast surgery: a qualitative exploration. J Cancer Surviv 2021; 15:224-233. [PMID: 32816201 PMCID: PMC7966197 DOI: 10.1007/s11764-020-00926-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/01/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this research was to explore women's experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). MATERIAL AND METHODS A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were "physical and sensory symptoms," "impact of scar symptoms," "personal factors," "impact of scar interventions," and "change over time." RESULTS The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. CONCLUSION Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. IMPLICATIONS FOR CANCER SURVIVORS Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.
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Affiliation(s)
- Kristel E. Everaars
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Marlies Welbie
- Research Center Healthy and Sustainable Living, Research group Methodology of Practice-Based Research, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Esther P. M. Tjin
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Erik H. de Laat
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
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Rindom MB, Gunnarsson GL, Lautrup MD, Tos T, Hölmich PLR, Sørensen PJA, Thomsen JB. Good health-related quality-of-life and high patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back. J Plast Reconstr Aesthet Surg 2020; 74:1752-1757. [PMID: 33676866 DOI: 10.1016/j.bjps.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/01/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This paper presents the results of a randomized controlled trial (RCT) that focus on health-related quality-of-life (QoL) and patient-reported satisfaction following breast reconstruction with pedicled flaps from the back. MATERIALS & METHODS We included women for unilateral delayed breast reconstruction. Patients were randomized to reconstruction by either a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TAP) flap. Assessment of QoL and patient satisfaction was made using two different patient-reported outcome measures (PROMs): The EORTC QLQ-30 and the Breast-Q questionnaire for post-mastectomy breast reconstruction. RESULTS A total of 50 women were enrolled over a two-year period and allocated to reconstruction. Forty patients completed both surgery and follow-up and were included in the analysis - 18 in the LD group and 22 in the TAP group. The EORTC QLQ-30 was administered at the baseline and at one-year follow-up. There was no significant effect of introducing the TAP flap on either the summary score, the global QoL-score or the financial impact-score when compared to the LD flap. The Breast-Q questionnaire was administered only at one-year follow-up. There was no significant difference between the two groups for the scores for satisfaction with the reconstructed breast, the overall outcome and QoL related to psycho-social, sexual and physical well-being. CONCLUSION Women from both groups report high satisfaction and QoL following the reconstruction. The quality of the dataset and the study design are, however, insufficient to rule out any existing difference. A larger cohort, longer follow-up and different design are warranted to assess the true clinical significance these reconstructions might have on satisfaction and QoL.
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Affiliation(s)
- Mikkel Børsen Rindom
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | | | - Tina Tos
- Department of Plastic Surgery, Herlev & Gentofte Hospital, Herlev, Denmark
| | | | | | - Jørn B Thomsen
- Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Jankowska-Polańska B, Świątoniowska-Lonc N, Ośmiałowska E, Gałka A, Chabowski M. The Association Between Illness Acceptance and Quality of Life in Women with Breast Cancer. Cancer Manag Res 2020; 12:8451-8464. [PMID: 32982439 PMCID: PMC7500846 DOI: 10.2147/cmar.s261624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Breast cancer is the most common cause of cancer death in women. Aim The aim of the study was to investigate the association between illness acceptance and quality of life (QoL) in patients with breast cancer. Patients and Methods The study included 150 patients who had undergone surgery for breast cancer. The following standardized questionnaires were used: the Acceptance of Illness Scale (AIS), the EORT QLQ-C30 (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30), and the EORT QL-BR 23 (Quality of Life Questionnaire for Breast Cancer) for QoL evaluation. Socio-clinical data were obtained from the patients' medical records. Results In the study group, the overall QoL score was 62.67±17.11 in the BCT group, 63±14.3 in the MTX group, and the highest: 65.5±20.2 in the reconstruction group. Comparative analysis showed that patients in the BCT group reported significantly more fatigue (p=0.007) and appetite loss (p=0.032) than those in the MTX+R group. Patients in the MTX group were significantly less satisfied with their body image (p=0.001) and experienced more financial troubles (p=0.013) than the remaining patients. Patients in the MTX+R group reported significantly better sexual function and more sexual enjoyment than the remaining patients (p<0.001). All patients scored high for illness acceptance, though patients in the MTX group had lower scores (28.17±7.2) than the others: 31.84±6.51 in the BCT group and 32.78±7.97 in the MTX+R group. The comparative analysis of QoL according to the level of AIS showed the significantly better QoL and less intense symptoms within all the domains except for the insomnia and hair loss domains in the group of high AIS in comparison with medium and lack of AIS. Acceptance of illness significantly correlated with 4 domains of the QLQ-C30 (p<0.05). The correlation between illness acceptance and overall QoL was positive (r=0.243; p=0.003) - the higher the acceptance, the better the QoL. Correlations with pain, diarrhoea, and financial difficulties were negative. Illness acceptance was positively correlated with QoL in 3 domains of the EORTC-BR23: body image (p<0.001), sexual function (p=0.015), and sexual enjoyment (p=0.047), and negatively with the "treatment side effects" (p=0.011). Conclusion The level of illness acceptance varies depending on the treatment method, and is the lowest in the group of women having undergone a mastectomy, and the highest in patients after a mastectomy with immediate breast reconstruction. Acceptance of illness improves the QoL of women treated for breast cancer, regardless of the specific treatment method.
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Affiliation(s)
- Beata Jankowska-Polańska
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw 51-618, Poland
| | - Natalia Świątoniowska-Lonc
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw 51-618, Poland
| | - Edyta Ośmiałowska
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw 51-618, Poland
| | - Aneta Gałka
- Division of Nervous System Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw 51-618, Poland
| | - Mariusz Chabowski
- Division of Oncology and Palliative Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw 51-618, Poland.,Department of Surgery, 4th Military Teaching Hospital, Wroclaw 50-981, Poland
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Obesity and Breast Reconstruction: Complications and Patient-Reported Outcomes in a Multicenter, Prospective Study. Plast Reconstr Surg 2020; 145:481e-490e. [DOI: 10.1097/prs.0000000000006543] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quinlan-Woodward J, Gode A, Dusek JA, Reinstein AS, Johnson JR, Sendelbach S. Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy. Oncol Nurs Forum 2017; 43:725-732. [PMID: 27768139 DOI: 10.1188/16.onf.725-732] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To compare the effect of acupuncture to a standard-of-care (control) group on pain, nausea, anxiety, and ability to cope.
. DESIGN Pilot randomized, controlled trial.
. SETTING Abbott Northwestern Hospital, a large, urban, tertiary care hospital in Minneapolis, Minnesota.
. SAMPLE 30 adult women undergoing surgery for breast cancer.
. METHODS Women were randomly assigned to two hospital-based acupuncture treatments versus usual care after breast cancer surgery. Pain, nausea, anxiety, and the patient's ability to cope pre- and post-treatment were compared within and between groups at two different time points postoperatively.
. MAIN RESEARCH VARIABLES Mean change in pain, nausea, anxiety, and ability to cope by treatment group.
. FINDINGS Compared to women assigned to the control group, women who received acupuncture reported a statistically significant greater reduction in pain, nausea, anxiety, and increase in ability to cope on the first postoperative day and in pain on the second postoperative day following mastectomy surgery.
. CONCLUSIONS Acupuncture delivered postoperatively in the hospital after mastectomy can reduce the severity of symptoms experienced, as well as increase the patient's ability to cope with her symptoms. However, before implementation as a standard of care, further research needs to be conducted.
. IMPLICATIONS FOR NURSING Acupuncture adds a nonpharmacologic intervention for symptom management in women undergoing mastectomies for breast cancer.
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Affiliation(s)
| | - Autumn Gode
- Penny George Institute for Health and Healing
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16
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Magnusson MR. Commentary on: The Impact of Animation Deformity on Quality of Life in Post-Mastectomy Reconstruction Patients. Aesthet Surg J 2017; 37:537-539. [PMID: 28333191 DOI: 10.1093/asj/sjx025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark R. Magnusson
- Dr Magnusson is a plastic surgeon in private practice in East Toowoomba, Queensland, Australia
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Timman R, Gopie JP, Brinkman JN, Kleijne A, Seynaeve C, Menke-Pluymers MBE, ter Kuile MM, Tibben A, Mureau MAM. Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study. PLoS One 2017; 12:e0174455. [PMID: 28346508 PMCID: PMC5367706 DOI: 10.1371/journal.pone.0174455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background Substantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term. Methods PD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age. Results One or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD. Conclusions PD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result.
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Affiliation(s)
- Reinier Timman
- Department of Psychiatry, section of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Jessica P. Gopie
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Nick Brinkman
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annelies Kleijne
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marian B. E. Menke-Pluymers
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Breast Clinic, Albert Schweitzer Hospital, Rotterdam, the Netherlands
| | - Moniek M. ter Kuile
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc A. M. Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Manne SL, Topham N, D’Agostino TA, Virtue SM, Kirstein L, Brill K, Manning C, Grana G, Schwartz MD, Ohman-Strickland P. Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psychooncology 2016; 25:1424-1433. [PMID: 26383833 PMCID: PMC9890719 DOI: 10.1002/pon.3984] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/10/2015] [Accepted: 08/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study aim was to test the acceptability and preliminary efficacy of a novel interactive web-based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy. METHODS Fifty-five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later. RESULTS In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow-up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow-up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions. CONCLUSION A widely available free pamphlet and a web-based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web-based decision support aid. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sharon L. Manne
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA,Correspondence to: Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick NJ 08903, USA.
| | - Neal Topham
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Thomas A. D’Agostino
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Shannon Myers Virtue
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Laurie Kirstein
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Kristin Brill
- MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA
| | | | - Generosa Grana
- MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA
| | | | - Pamela Ohman-Strickland
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Potter S, Holcombe C, Blazeby J. Response to: Gschwantler-Kaulich et al (2016) Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - A prospective randomized trial doi:10.1016/j.ejso.2016.02.007. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1767-1768. [PMID: 27424788 DOI: 10.1016/j.ejso.2016.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- S Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, UK.
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - J Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, UK
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Associations between Reoperations and Psychological Factors after Contralateral Risk-Reducing Mastectomy: A Two-Year Follow-Up Study. Int J Breast Cancer 2016; 2016:4604852. [PMID: 27313897 PMCID: PMC4899600 DOI: 10.1155/2016/4604852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/24/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction. The aim of the study was to investigate associations between reoperations after contralateral risk-reducing mastectomies (CRRM) and emotional problems, body image, sexuality, and health related quality of life (HRQoL) in women with breast cancer and hereditary high risk. Patients and Methods. Patients scheduled for CRRM with breast reconstruction between 1998 and 2010 completed questionnaires, comprised of SF-36, the Hospital Anxiety and Depression Scale, the Body Image Scale, and the Sexual Activity Questionnaire, preoperatively and two years after CRRM. Data on reoperations was collected from medical charts. Results. A total of 80 women participated, with a response rate of 61 (76%) preoperatively and 57 (71%) at the two-year follow-up. At the two-year assessment, 44 (55%) patients had undergone ≥1 reoperation (reoperation group), whereas 36 (45%) had not (no reoperation group). No statistically significant differences between the groups were found for HRQoL, sexuality, anxiety, or depression. A higher proportion of patients in the “reoperation group” reported being dissatisfied with their bodies (81% versus 48%, p = 0.01). Conclusion. The results suggest associations between reoperation following CRRM with breast reconstruction and body image problems. Special attention should be paid to body image problems among women who are subject to reoperations after CRRM.
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Hahn EA, Segawa E, Kaiser K, Cella D, Smith BD. Health-related quality of life among women with ductal carcinomain situor early invasive breast cancer: validation of the FACT-B (version 4). ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1134259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Patient-reported outcome measures in reconstructive breast surgery: is there a role for generic measures? Plast Reconstr Surg 2015; 135:479e-490e. [PMID: 25719712 DOI: 10.1097/prs.0000000000000954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-reported outcomes provide an invaluable tool in the assessment of outcomes in plastic surgery. Traditionally, patient-reported outcomes have consisted of either generic or ad hoc measures; however, more recently, there has been interest in formally constructed and validated questionnaires that are specifically designed for a particular patient population. The purpose of this systematic review was to determine whether generic measures still have a role in the evaluation of breast reconstruction outcomes, given the recent popularity and push for use of specific measures. METHODS A systematic review was performed to identify all articles using patient-reported outcomes in the assessment of postmastectomy breast reconstruction. Frequency of use was tabulated and the most frequently used tools were assessed for success of use, using criteria described previously by the Medical Outcomes Trust. RESULTS To date, the most frequently used measures are still generic measures. The 36-Item Short-Form Health Survey was the most frequently used and most successfully applied showing evidence of responsiveness in multiple settings. Other measures such as the Hospital Anxiety and Depression Scale, the Hopwood Body Image Scale, and the Rosenberg Self-Esteem Scale were able to show responsiveness in certain settings but lacked evidence as universal tools for the assessment of outcomes in reconstructive breast surgery. CONCLUSIONS Despite the recent advent of measures designed specifically to assess patient-reported outcomes in the breast reconstruction population, there still appears to be a role for the use of generic instruments. Many of these tools would benefit from undergoing formal validation in the breast reconstruction population.
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Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Health Related Quality of Life. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bezerra KB, Silva DSMD, Chein MBDC, Ferreira PR, Maranhão JKP, Ribeiro NL, Mochel EG. Qualidade de vida de mulheres tratadas de câncer de mama em uma cidade do nordeste do Brasil. CIENCIA & SAUDE COLETIVA 2013; 18:1933-41. [DOI: 10.1590/s1413-81232013000700008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi avaliar a qualidade de vida de mulheres tratadas cirurgicamente de câncer de mama no Hospital de Referência Estadual em Oncologia de São Luís (MA). A qualidade de vida foi avaliada pelo Functional Assessment of Cancer Therapy-Breast (FACT-B). As variáveis foram expressas em média e desvio padrão; e a análise estatística constou da Anova ou Kruskal Wallis e Teste t de Student ou Mann-Whitney. O nível de significância foi α < 5%. Na estatística foram usados o Stata 9.0 e o BioEstat 5.0. Participaram 197 mulheres com idade média de 53,0 ± 11,7 anos. Os valores médios do FACT-B demonstraram tendência para boa qualidade de vida, sendo o domínio Emocional o mais comprometido e a Subescala Câncer a mais favorável. O tipo de cirurgia influenciou os domínios Social, Emocional e Subescala câncer do questionário. A cirurgia não conservadora apresentou piores níveis de qualidade de vida. Viu-se relação estatística significante entre o tempo de cirurgia e os domínios Físico, Emocional e Funcional, bem como entre tempo de cirurgia e os escores do FACT-B. O tratamento adjuvante influenciou todos os domínios do FACT-B. A qualidade de vida encontrada foi relativamente boa, mas influenciada negativamente pela cirurgia não conservadora, pelo menor tempo desde a cirurgia e pelas terapias adjuvantes.
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Rubin LR, Chavez J, Alderman A, Pusic AL. 'Use what God has given me': difference and disparity in breast reconstruction. Psychol Health 2013; 28:1099-120. [PMID: 23557084 DOI: 10.1080/08870446.2013.782404] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared to white women in the USA. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality and biomedicalisation. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualisations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use 'what God has given'. For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients' skin tones. We suggest that a framework of 'stratified biomedicalization' better addresses the complexities of race, class and gender that inform preference, access and recommendations for breast reconstruction, and focuses attention on access to high and low-tech interventions.
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Affiliation(s)
- Lisa R Rubin
- a Department of Psychology , The New School for Social Research , New York , NY , USA
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Garvey PB, Villa MT, Rozanski AT, Liu J, Robb GL, Beahm EK. The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients. Plast Reconstr Surg 2013; 130:991-1000. [PMID: 23096600 DOI: 10.1097/prs.0b013e318267efc5] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses. METHODS The authors retrospectively analyzed consecutive implant- and abdominal-based free flap breast reconstructions performed in obese patients between 2005 and 2010 by utilizing the World Health Organization obesity classifications: class I, 30.0 to 34.9 kg/m2; class II, 35.0 to 39.9 kg/m2; and class III, ≥40 kg/m2. Primary outcome measures included flap failures and overall complications. Logistic regression analysis identified associations among patient, defect, and reconstructive characteristics and surgical outcomes. RESULTS The analysis included 990 breast reconstructions (548 flaps versus 442 implants) in 700 patients. Mean follow-up was 17 months. Age, smoking, medical illness, and body mass index greater than 37 predicted overall complications on regression analysis. Implants demonstrated a higher failure rate (15.8 percent) than flaps (1.5 percent). Although failure rates were similar for immediate and delayed flap reconstructions overall (1.3 versus 1.9 percent) and among obesity classifications, there was a trend toward more implant failures in immediate rather than delayed reconstructions (16.8 versus 5.3 percent). Differences between immediate implant versus flap reconstruction failure rates were highest among more obese patients [class II (24.7 versus 1.3 percent) and class III (25.4 versus 0 percent) compared with class I (11.7 versus 1.4 percent)]. CONCLUSIONS Obese patients (particularly class II and III) experience higher failure rates with implant-based breast reconstruction, particularly immediate reconstruction. Free flap techniques or delayed implant reconstruction may be warranted in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Patrick B Garvey
- Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center
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Ward J, Potter S, Blazeby J. Outcome reporting for reconstructive breast surgery: The need for consensus, consistency and core outcome sets. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2012; 38:1020-1. [DOI: 10.1016/j.ejso.2012.07.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 06/20/2012] [Accepted: 07/19/2012] [Indexed: 11/30/2022]
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Fallbjörk U, Frejeus E, Rasmussen BH. A preliminary study into women’s experiences of undergoing reconstructive surgery after breast cancer. Eur J Oncol Nurs 2012; 16:220-6. [DOI: 10.1016/j.ejon.2011.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 11/26/2022]
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Gopie JP, Timman R, Hilhorst MT, Hofer SOP, Mureau MAM, Tibben A. The short-term psychological impact of complications after breast reconstruction. Psychooncology 2011; 22:290-8. [DOI: 10.1002/pon.2089] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 01/22/2023]
Affiliation(s)
- Jessica P. Gopie
- Centre for Human and Clinical Genetics; Leiden University Medical Center; Leiden The Netherlands
| | - Reinier Timman
- Department of Medical Psychology and Psychotherapy; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Medard T. Hilhorst
- Department of Medical Ethics and Philosophy; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Stefan O. P. Hofer
- Division of Plastic Surgery, University Health Network; University of Toronto; Toronto ON Canada
| | - Marc A. M. Mureau
- Department of Plastic and Reconstructive Surgery; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Aad Tibben
- Centre for Human and Clinical Genetics; Leiden University Medical Center; Leiden The Netherlands
- Department of Clinical Genetics; Erasmus University Medical Center; Rotterdam The Netherlands
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Carey M, Noble N, Sanson-Fisher R, Mackenzie L. Identifying psychological morbidity among people with cancer using the Hospital Anxiety and Depression Scale: time to revisit first principles? Psychooncology 2011; 21:229-38. [DOI: 10.1002/pon.2057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/31/2011] [Accepted: 08/02/2011] [Indexed: 01/06/2023]
Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Natasha Noble
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Robert Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
| | - Lisa Mackenzie
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Newcastle New South Wales Australia
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Santos DB, Vieira EM. Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura. CIENCIA & SAUDE COLETIVA 2011; 16:2511-22. [DOI: 10.1590/s1413-81232011000500021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 02/18/2010] [Indexed: 12/20/2022] Open
Abstract
A mulher passa por um importante processo de reformulação da imagem corporal quando lida com o câncer de mama. Este artigo objetiva a compreensão da relação que o câncer de mama e seus tratamentos têm no processo de (re)elaboração da imagem corporal das mulheres, visando assim ao fomento de subsídios para a formação e a capacitação de profissionais de saúde mais atentos à promoção da qualidade de vida delas. Foi realizada uma revisão sistemática da literatura de artigos científicos publicados entre 2004 e 2009 disponíveis em três bases de dado; 56 artigos foram revisados e agrupados em quatro categorias. Destacamos a necessidade de mais estudos que contemplem características socioculturais de mulheres com câncer de mama, sobre diferenças na (re)elaboração da imagem corporal de mulheres jovens e de mulheres mais velhas, e de publicações brasileiras sobre a experiência pessoal e aspectos socioculturais específicos de mulheres com câncer de mama.
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A Systematic Review of the Clinical Evidence to Guide Treatment Recommendations in Breast Reconstruction Based on Patient- Reported Outcome Measures and Health-Related Quality of Life. Ann Surg 2010; 252:929-42. [DOI: 10.1097/sla.0b013e3181e623db] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Falk Dahl CA, Reinertsen KV, Nesvold IL, Fosså SD, Dahl AA. A study of body image in long-term breast cancer survivors. Cancer 2010; 116:3549-57. [DOI: 10.1002/cncr.25251] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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