Psychosocial Factors Affecting the Therapeutic Decision-making and Postoperative Mood States in Japanese Breast Cancer Patients who underwent Various Types of Surgery: Body Image and Sexuality

Key factors in the decision-making process for mastectomy alone or breast reconstruction: A qualitative analysis

Breast cancer is the most common cancer to affect New Zealand women. Women diagnosed face several decisions regarding surgical treatment, including whether to undergo lumpectomy, mastectomy, or breast reconstruction. Reconstructive surgery adds an additional layer of complexity, with several reconstructive options, each associated with differing surgical and recovery times. Furthermore, surgical decisions are often made under time-pressure and significant diagnostic distress, therefore provision of good information to support decision-making is crucial to adequately inform women of their options. We interviewed 24 women who had undergone breast surgery within the preceding 12 months to assess the key factors leading to their decision to opt for their chosen surgical procedure. Interviews revealed that decision-making was complex and involved multiple factors. Women were ultimately confronted with assessing feminine identity versus survival. Whether opting for breast reconstruction or not, women were fearful of what surgery would involve and how their reconstructed breast or mastectomy scar might look following surgery. Shared decision-making between patient and clinician can mitigate this fear and provide women with a sense of autonomy over their health decisions. Provision of visual depictions of surgical outcomes was not routinely provided to those interviewed but was expressed as important to help women manage surgical expectations. Therefore our findings support the multi-modal presentation of diagnostic and treatment information to support decision-making. Likewise, women reported feeling unsupported in their decision not to undergo breast reconstruction, suggesting a need to develop resources to provide women with positive discussions about 'going flat'.

The role of breast reconstruction choice on body image patient-reported outcomes at four years post-mastectomy for breast cancer: A longitudinal prospective cohort study

OBJECTIVES

To examine the impact of breast reconstruction on women's perceptions of body image over time and to assess the influence of sociodemographic variables on body image.

METHODS

A prospective, longitudinal cohort study, using validated breast cancer-specific questionnaires, to compare patient-reported outcomes in women choosing immediate (n = 61), delayed (n = 16) or no (n = 23) breast reconstruction.

RESULTS

One hundred women completed baseline questionnaires that included items on body image; 30 women completed all four annual follow-up sets, while 20 women completed baseline only. The three groups were well matched at baseline and similar trajectories in body image measures were identified over 48 months in all groups. At 12 months post-mastectomy, significant changes were seen in eight of the 10 subscales; this reduced to seven subscales at 24 months and four at 36 months. By 48 months, only three subscales remained significantly different to baseline scores: women remained less vulnerable and had fewer limitations (improved outcomes); the one worse outcome was persistently higher levels of arm concern. Three of the sociodemographic variables (health insurance, age and employment status) showed significant inter-group differences at some time points.

CONCLUSION

These findings suggest women recover from the negative impact of mastectomy on body image within four years of surgery, whether they have immediate, delayed or no reconstruction. Our results provide some indirect evidence that having a choice of BR options is important, regardless of the choice made. Four years appears to be a suitable follow-up period for future studies in this area.

Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review

BACKGROUND

Deciding to have a mastectomy can be challenging for women. An understanding of the decision-making experience related to mastectomy would contribute to improving the support of women making this decision.

OBJECTIVE

The aim of this study was to understand women's decision-making experience related to mastectomy.

METHODS

Studies published from 2000 to 2020 were identified by searching databases (CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science, and China National Knowledge Infrastructure) and reference lists of previous reviews. Methodological quality of these studies was assessed using the Mixed Methods Appraisal Tool version 2018. Data were analyzed using content comparison analysis.

RESULTS

Twenty-three quantitative and 6 qualitative studies were included in this review. Four themes emerged from the included studies: participation in decision-making, seeking information about treatment choices, postoperative perceptions of mastectomy decision-making, and factors related to mastectomy choice. Several negative experiences related to decision-making were identified. A number of clinical, sociodemographic, and psychosocial factors that influenced women to choose a mastectomy were identified.

CONCLUSIONS

This review provides in-depth information about decision-making experiences and factors that influence the choice of mastectomy. Research is required about women who have had a mastectomy using standardized instruments to investigate their decision-making experiences. Studies are also necessary in non-Western countries.

IMPLICATIONS FOR PRACTICE

The factors and experiences identified in this review may help nurses to assist in the treatment decision-making process. Further research is required regarding breast care and other nurses' involvement in the decision-making process related to mastectomy.

Quality of Life in Women Subjected to Surgical Treatment of Breast Cancer Depending on the Procedure Performed within the Breast and Axillary Fossa-A Single-Center, One Year Prospective Analysis

The aim of this study was to evaluate the quality of life of patients undergoing surgical treatment of breast cancer depending on the type of procedure involving the breast (mastectomy vs. breast conserving treatment) and axillary fossa (sentinel lymph node biopsy vs. axillary lymph node dissection). The prospective study was carried out in a group of 338 females undergoing breast cancer treatment. Study variables were assessed by means of a diagnostic survey using standardized QLQ C30 and BR23 questionnaires as well as the Acceptance of Illness Scale and Mini-MAC scales. The quality of life was assessed at threetime points: on the day before the surgical procedure (I assessment) as well as three and 12 months after surgery (II and III assessment). Statistically significant differences between study groups were observed in the overall quality of life subscale (I, II, III—p < 0.0001), physical functioning (I—p < 0.0001; II—p = 0.0413; III—p < 0.0001), role functioning (I—p = 0.0002; III—p < 0.0001), emotional functioning (III—p = 0.0082), cognitive functioning (I—p = 0.0112; III—p < 0.0001), social functioning (III—p < 0.0001), body image (I, II, III—p < 0.0001), and sexual functioning (I—p = 0.0233; III—p = 0.0011). In most symptomatic scales, significant (p < 0.05) differences were also noted. Mastectomy and limfadenectomy patients were significantly (p < 0.0001) more prone to present with destructive coping strategies one year after surgery. Breast conserving therapy is associated with better quality of life outcomes as compared to mastectomy. Sentinel lymph node biopsy is associated with a lower intensity of adverse changes in multiple dimensions of patients’ functioning.

Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center

PURPOSE

To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision.

METHODS

Women with stage I-III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction.

RESULTS

A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost.

CONCLUSIONS

Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.

Correlates of regret with treatment decision-making among Japanese women with breast cancer: results of an internet-based cross-sectional survey

Background

Satisfaction with medical decisions among patients with cancer is associated not only with the results of decisions they make but also with how they make those decisions. To elucidate the decision-making process among Japanese women with breast cancer, we explored the correlates of regret with patients’ treatment decision-making.

Methods

An Internet-based cross-sectional survey was utilized. Japanese women (N = 467) who self-reported that they had been diagnosed with stage 0­II breast cancer participated. Data regarding their decisional role (active, collaborative, or passive) in treatment decision-making, their most regrettable experience regarding their decision-making, the importance of various factors related to decision-making at the time, and clinical and sociodemographic factors were obtained. A forced-entry logistic regression analysis was performed on the likelihood that patients would have some regrets regarding the decision-making process.

Results

About half the women expressed some regret (51.4%). Women who had a mastectomy were significantly more likely to have regret than women who had breast conserving surgery. Correlates of regret differed by surgical type. For women who had a mastectomy, those who were aged ≥50 years when diagnosed, or who made their decisions collaboratively with their doctors were significantly less likely to have regret with the decision-making. For women who had breast conserving surgery, those who worked on a contract or part-time basis or whose decision-making roles matched their preferred role were significantly less likely to have regret. Among women who reported some regret, 23.8% expressed that their most regrettable experience concerned gathering information, while 21.3% regretted not consulting with others. For women who were diagnosed at a younger age, the influence on their sex life and pregnancy and childbirth was more important when making their treatment decisions than for women diagnosed an older age.

Conclusions

Approximately half of the Japanese women with breast cancer in this study reported some regret in the treatment decision-making process. Effective participation in decision-making differed by surgical types. Additionally, women who are diagnosed with breast cancer at a relatively younger age, as compared to those who are older, may need additional information and support regarding their sex life and fertility after cancer treatment.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0783-5) contains supplementary material, which is available to authorized users.

Smallest detectable change and test-retest reliability of a self-reported outcome measure: Results of the Center for Epidemiologic Studies Depression Scale, General Self-Efficacy Scale, and 12-item General Health Questionnaire

RATIONALE, AIMS, AND OBJECTIVES

This study aims to examine the smallest detectable change (SDC) and test-retest reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and 12-item General Health Questionnaire (GHQ-12).

METHOD

We tested 154 young adults at baseline and 2 weeks later. We calculated the intra-class correlation coefficients (ICCs) for test-retest reliability with a two-way random effects model for agreement. We then calculated the standard error of measurement (SEM) for agreement using the ICC formula. The SEM for agreement was used to calculate SDC values at the individual level (SDC_ind ) and group level (SDC_group ).

RESULTS

The study participants included 137 young adults. The ICCs for all self-reported outcome measurement scales exceeded 0.70. The SEM of CES-D was 3.64, leading to an SDC_ind of 10.10 points and SDC_group of 0.86 points. The SEM of GSES was 1.56, leading to an SDC_ind of 4.33 points and SDC_group of 0.37 points. The SEM of GHQ-12 with bimodal scoring was 1.47, leading to an SDC_ind of 4.06 points and SDC_group of 0.35 points. The SEM of GHQ-12 with Likert scoring was 2.44, leading to an SDC_ind of 6.76 points and SDC_group of 0.58 points.

CONCLUSION

To confirm that the change was not a result of measurement error, a score of self-reported outcome measurement scales would need to change by an amount greater than these SDC values. This has important implications for clinicians and epidemiologists when assessing outcomes.

Patients' experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction

PURPOSE

Breast cancer patients have the option to choose a breast reconstruction after mastectomy. A range of studies have postulated that patients' individually appraised significance of their breast is an important factor in the decision for or against breast reconstruction. This study explored the individually perceived significance of the breast among patients with and without breast reconstruction and its correlation with postoperative satisfaction.

METHODS

Ten patients without breast reconstruction, and ten patients with immediate breast reconstruction after mastectomy participated in the study. The perceived importance of the breast and the pre-and postoperative esthetic satisfaction of the patients were obtained using an 11-point Likert scale. Qualitative interviews explored patients' views on the meaning of their breast and their experience after surgery.

RESULTS

Patients who had decided for breast reconstruction rated the importance of their breast for femininity (p = 0.004) and attractiveness (p = 0.037) significantly higher than patients without reconstruction. The qualitative data provide evidence that the breast of a woman fulfills a variety of intrapsychic and interactional functions. Difficulties in integrating the reconstructed breast into the body image were reported. A high importance of the breast correlated significantly with a decrease in satisfaction with the breast after reconstruction (rs = -0.652, p = 0.041).

CONCLUSIONS

Patients who found their breast to be highly important were more likely to decide for a reconstruction. Mastectomy has an impact on various psychosocial variables but impairments may also occur after breast reconstruction. Patients reporting a high significance of their breast showed the greatest decrease in satisfaction with their breast after reconstruction.

Preoperative breast size affects reconstruction status following mastectomy

Much research has been devoted to why women choose not to be reconstructed following mastectomy. The effect of breast size has not been well explored. The authors aimed to assess the relationship between breast size and reconstructive choices. A single-center retrospective review of women undergoing mastectomy between 2011 and 2014 was performed. Demographics, surgical variables, and reconstruction decisions were analyzed using t tests, Mann-Whitney U tests, and chi-squared tests. Significant (P < .05) variables were included in a multivariable logistic regression model. About 610 patients were analyzed. The median mastectomy specimen weight was 572 g (62-5230 g), which did not correlate with BMI (P = .44). Women who underwent reconstruction had lighter mastectomy specimens, averaging 643 vs 848 g (P < .0001). A regression controlling for ethnicity, insurance status, number of comorbidities, age at mastectomy, cancer stage, BMI, specimen weight, and mastectomy laterality was constructed. Lower specimen weight (P = .005), lower cancer stage (P = .008), bilateral mastectomy (P = .042), and younger age at mastectomy (P < .0001) were significantly associated with reconstruction. Women with larger breasts were less likely to be reconstructed regardless of their BMI and comorbidities. Larger breasted women may be considered worse prosthetic reconstruction candidates due to increased complications and suboptimal aesthetic outcomes but may find the increased invasiveness and recovery of autologous reconstruction an unattractive alternative. Furthermore, it is possible that surgeons may be less supportive of breast reconstruction for larger breasted women if there are concerns about safety or the aesthetic quality of the result. In the future, qualitative research must be done to determine why more larger breasted women choose not to be reconstructed as well as develop better ways to increase their reconstructive options.

Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice

PURPOSE

Many studies have explored women's reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women's reasons for choosing a range of BR options, including no BR, in different settings and across time.

METHODS

Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains.

RESULTS

While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal; Feeling/looking good; Being practical; Influence of others; Relationship expectations; Fear; Timing; and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers.

CONCLUSIONS

Understanding women's reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their individual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.

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

Breast cancer and its treatment can significantly affect a woman's body image. As such, it would be useful to understand the importance or value these patients place on their appearance. We evaluated the factor structure of the Appearance Schemas Inventory-Revised (ASI-R), a measure of body image investment, with a sample of 356 breast cancer patients undergoing mastectomy and breast reconstruction. Using confirmatory and exploratory factor analyses, we found that a three-factor model demonstrated an improvement in fit over the original two-factor structure of the ASI-R. These factors were named Appearance Self-Evaluation, Appearance Power/Control, and Appearance Standards and Behavior. The three aforementioned factors demonstrated acceptable internal consistency reliabilities. Our findings have implications for the use of the ASI-R in an oncology setting, specifically for breast cancer patients undergoing reconstruction.

Patient-reported outcome measures in reconstructive breast surgery: is there a role for generic measures?

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.

Sexualidade e câncer de mama: uma revisão sistemática da literatura

O objetivo deste estudo foi compreender como o câncer de mama e seus tratamentos afetam a vivência da sexualidade da mulher acometida. Foi realizada uma revisão sistemática qualitativa de artigos científicos, publicados entre 2000 e 2010, disponíveis nas bases de dados PubMed, Web of Science, LILACS e SciELO. Foram obtidos 50 artigos cujos textos foram categorizados segundo análise de conteúdo temática. Foram identificadas seis categorias temáticas: a cirurgia mamária e os demais tratamentos para o câncer de mama; a experiência da mulher acometida; o relacionamento afetivo-sexual; estudos sobre relação entre sexualidade e características específicas do câncer; os profissionais de saúde e a atenção à sexualidade; e propostas para amenizar as consequências negativas dos tratamentos na sexualidade. Há necessidade de novos estudos a respeito dos aspectos culturais da sexualidade, diversidade sexual, relacionamento com o parceiro, formação do profissional de saúde e intervenções em sexualidade no contexto do câncer de mama.

Positive and negative aspects of well-being as correlates of breast reconstruction decision

PURPOSE

The aim of the study was to explore the role of positive and negative aspects of well-being in a breast reconstruction decision, described in terms of the trans-theoretical model of change (TTM).

METHODS

The study comprised 216 women after total mastectomy in the cross-sectional design. The positive aspects of well-being were measured using the Rosenberg Self-Esteem Scale and Generalised Self-Efficacy Scale; the negative aspects were assessed using the Beck Depression Inventory and State-Trait Anxiety Inventory (T-Anxiety scale).

RESULTS

The multinomial logistic regression analyses were implemented, and the action stage was chosen as a relevant category. McFadden's pseudo R-squared for positive, negative and combined aspects of well-being models equalled 0.28, 0.13 and 0.27, respectively. For the first model, the differential effects were observed for well-being, age and relationship status (54 % correctly classified cases), whereas for the model with negative aspects-only age and well-being (44 % correctly classified cases). For a model combining two aspects of well-being, the pattern was similar to the one observed for positive well-being (53 % correctly classified cases). The likelihood of classifying women in the action stage rather than in the pre-contemplation stage was determined by three variables: being in a relationship, better well-being and younger age. For the contemplation stage, the same relations were obtained for well-being and age. Finally, for the preparation stage, the well-being effect disappeared.

CONCLUSION

The results suggest that positive rather than negative aspects of well-being, after control for sociodemographic variables, may be significant correlates of breast reconstruction decision.

Aspects of body image after mastectomy due to breast cancer - a two-year follow-up study

PURPOSE

This 2-year follow-up study explores aspects of body image after mastectomy due to breast cancer.

MATERIALS AND METHODS

This population-based study included 76 women living in northern Sweden who, during November 2006 to October 2007, underwent mastectomy due to breast cancer. The women completed a questionnaire entitled "Life After Mastectomy (LAM)" 10 months after the mastectomy and again 2 years later. We used SPSS version 18.0 for data processing and analysis.

RESULTS

The findings indicate that few significant changes in body image had taken place during the 2-year interval between the first and second completion of the questionnaire. An exception was a significant decrease in feelings of sexual attractiveness and comfort during sexual intimacy. At follow-up, 21% of the women had undergone breast reconstruction (BR). They were significantly younger than the women who had not had BR (53 vs. 63 years). Besides being younger, no other significant differences could be found between those women who had undergone BR and those who had not. The fact that the decrease in sexual attractiveness and feelings of comfort during sexual intimacy also applied to the subgroup of women who had had BR may therefore be surprising. A better understanding of issues related to breast cancer treatment and sexual function is vital.

CONCLUSION

It is important for health care professionals to be aware of problems related to sexual intimacy and to be prepared not just to provide information about these, but also to reflect on expectations vs. reality together with the women.

Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex

OBJECTIVE

Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer.

METHODS

An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM.

RESULTS

BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility).

CONCLUSION

This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery.

PRACTICE IMPLICATIONS

BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team.

An exploration of patient decision-making for autologous breast reconstructive surgery following a mastectomy

OBJECTIVE

The aim of this study was to examine patients' experiences of the decision to undergo breast reconstructive surgery following mastectomy.

METHOD

21 Women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants' experience of the decision-making process. The recorded interviews were transcribed verbatim and analyzed using "framework analysis".

RESULTS

Women who underwent immediate reconstruction spoke of the convenience of undergoing only one operation with regards to juggling work and childcare arrangements. For women who underwent delayed reconstructive surgery the reasons centre on dissatisfaction with wearing prosthesis. Others spoke of no choice, as immediate reconstruction was not offered as an option. However both groups did report similar influential factors and received and used similar informational content and informational sources in order to make their decision.

CONCLUSION

The study outlines the different motivations for undergoing immediate or delayed breast reconstruction and highlights that there is not always a choice offered to patients.

PRACTICE IMPLICATIONS

Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos.

The effect of a sexual life reframing program on marital intimacy, body image, and sexual function among breast cancer survivors

BACKGROUND

Despite increasing awareness related to sexual health for breast cancer survivors, health care providers are passive in addressing their sexual issues.

OBJECTIVE

The aims were to develop and investigate the effect of a sexual life reframing program on marital intimacy, body image, and sexual function (interest, dysfunction, and satisfaction) among breast cancer survivors.

METHODS

Breast cancer survivors participated in this quasi-experimental study. The sexual life reframing program focused on the physical, psychological, and relational aspects of sexual health elements, and it consisted of 6 weekly 2-hour sessions.

RESULTS

The participants reported poor body image and sexual function. There were no statistically significant differences in marital intimacy, body image, sexual interest, and sexual dysfunction following the program, although all the variables in the intervention group were improved. The sexual life reframing program was effective in increasing sexual satisfaction among breast cancer survivors.

CONCLUSION

This study suggests that the quality of sexual life in breast cancer survivors could be improved with the sexual life reframing program provided as part of supportive group care. This program may be more effective if targeted at couples rather than survivors only and if delivered earlier and for a longer period.

IMPLICATIONS FOR PRACTICE

The sexual life reframing program offers an opportunity to facilitate small-group dynamics that lay the ground for further contacts leading to earlier recognition of sexual problems and active involvement for sexual health improvement for breast cancer survivors and nurses. It could be utilized for survivor education or support groups to increase sexual satisfaction.

Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura

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.

Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?

OBJECTIVE

To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM).

BACKGROUND

A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices.

DESIGN

Literature search and narrative synthesis of data.

SYNTHESIS

Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients.

CONCLUSIONS

The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.

Differences between women who have and have not undergone breast reconstruction after mastectomy due to breast cancer

AIM

This study compares potential differences between women with breast cancer who after mastectomy had undergone breast reconstruction with those who had not.

MATERIAL AND METHODS

All women (N=149) in the northern medical region of Sweden who had undergone mastectomy in 2003 received a self-reported questionnaire entitled "Life After Mastectomy (LAM)" that included standardized measures of sociodemographic, decision-making process, breast reconstruction (BR) yes or no, sexuality, and body image. SPSS was used for data processing.

RESULTS

In total 85% of the women returned the questionnaire and of these 25% had undergone BR. In accordance with previous studies, we found that the mean age of the women in the BR group was significantly lower (52 vs. 64 years), they had a higher education, and a higher proportion were employed, influenced by the physician's opinion regarding BR, sexually active, and rated a negative impact concerning the factors attractiveness and body disclosure. A multiple regression analysis, however, showed that the choice to undergo breast reconstruction or not was only independently associated with age, feeling of attractiveness and sexual interest.

DISCUSSION

Age explained most differences found between the two groups. When researchers try to identify what differentiates the groups of women who undergo reconstruction between those who do not undergo reconstruction after mastectomy, it is thus necessary to take into consideration that the meanings of mastectomy, body image, attractiveness and similar variables may vary due to the phase of a woman's life. In conclusion, considering the impact of age is of paramount importance in future studies for our understanding of women's experiences.

Endoscopic-assisted skin-sparing mastectomy combined with sentinel node biopsy

Breast-conserving surgery (BCS) has been carried out as desirable choice for patients with early-stage breast cancer. However, many patients obliged to abandon BCS because of tumours accompanied by extended intraductal components or multiple tumours. The purpose of this study was to develop a novel endoscopic-assisted technique for skin-sparing mastectomy (SSM) combined with sentinel node biopsy (SNB), followed by immediate breast reconstruction with mammary prosthesis. Between April 2000 and November 2006, 33 patients diagnosed with primary breast cancer underwent endoscopic-assisted SSM. Immediate reconstruction with the mammary prosthesis was carried out in 30 of 33 patients. On postoperative histopathological diagnosis, 21 tumours were diagnosed as ductal carcinoma in situ or lobular carcinoma in situ. Twelve tumours were diagnosed as invasive carcinoma. Eight of 12 invasive carcinomas were accompanied by a wide spreading intraductal component. Two patients were diagnosed as having multicentric carcinomas, which made the standard breast-conserving treatment difficult. After a mean follow-up period of 51.2 months (range 16-86 months), neither locoregional recurrence nor distant metastasis has been detected. Thus, combining SSM and SNB with immediate reconstruction with the mammary prosthesis may offer the selected patients with early-stage breast cancer favourable aesthetic results without incurring additional oncological risks. The procedure could be an alternative treatment option for patients with widely spreading intraductal component or multiple tumours.