Quality of Life Indicators in Patients Operated on for Breast Cancer in Relation to the Type of Surgery-A Retrospective Cohort Study of Women in Serbia

[Psychological impacts of mastectomy in elderly people with breast cancer]

Aging is one of the main risk factors for breast cancer and one of the most common treatment options is surgery, including mastectomy, which can result in psychological impacts on women. The scope of this article is to conduct a bibliographical survey on the psychological impacts of mastectomy on elderly women with breast cancer. It involved an integrative literature review, conducted between August and September 2023, via the VHL portal, in the following databases: LILACS, BDENF, SciELO, MEDLINE and Google Scholar. A total of 2,021 articles were located, 22 of which were selected in line with the inclusion criteria. Among the psychological impacts, fear, anguish, sadness, feelings of loss, low self-esteem, shame, changes in body image, depression and anxiety stand out, as well as positive feelings such as resilience, hope, optimism, among others, however the predominance of negative feelings tend to prevail. The conclusion drawn is that the mastectomy process is experienced individually by each woman, bringing with it physical and psychological changes. Social support from family, friends and, especially, partners, are essential aspects of a woman's well-being and mental health.

The potential benefits of radiotherapy in elderly patients with early-stage triple-negative breast cancer

Background

Breast cancer (BC) is the most common cancer in women in the U.S. and a leading cause of cancer-related deaths. The incidence rises with age, especially in women over 70. Older patients often face multiple comorbidities, complicating treatment decisions. This study will analyze the role of radiotherapy (RT) in early-stage triple-negative breast cancer (TNBC) among elderly patients using the SEER database to assess its impact on survival outcomes.

Methods

The patients aged 70+ with T1-2N0-1M0 TNBC were selected from the SEER database (2010-2015) according to specific inclusion and exclusion criteria. Statistical analyses involved chi-square tests, propensity score matching (PSM), and Cox regression to identify risk factors. A nomogram was developed, and Kaplan-Meier analysis compared overall (OS) and breast cancer-specific survival (BCSS) across different groups.

Results

A total of 3,024 elderly patients with early-stage TNBC were analyzed. After employing PSM to eliminate baseline differences, survival analysis indicated that the breast-conserving surgery (BCS) group could benefit from RT (OS, HR = 0.68, p < 0.001; BCSS, HR = 0.64, p = 0.001). Cox regression analysis on the non-RT cohort within the BCS group identified age, tumor grade, and T stage as independent risk factors. Subsequently, a nomogram was developed to stratify patients and found that RT significantly improved OS and BCSS in the intermediate-risk (OS, HR = 0.49, 95% CI = 0.34-0.71, p = 0.001; BCSS, HR = 0.40, 95% CI = 0.21-0.77, p = 0.018) and high-risk group (OS, HR = 0.67, 95% CI = 0.55-0.81, p < 0.001; BCSS, HR = 0.61, 95% CI = 0.45-0.83, p = 0.007), while showing no significant benefit in the low-risk group (all p-values > 0.05).

Conclusion

RT significantly improves OS and BCSS in early-stage TNBC patients after BCS, particularly for intermediate to high-risk individuals, while low-risk patients may omit it.

Dynamics in Quality of Life of Breast Cancer Patients Following Breast-Conserving Surgery Versus Mastectomy: Protocol for Systematic Review and Meta-Analysis

Background: Quality of life (QoL) may change in female patients with breast cancer over time due to its dynamic construct. Recent studies have provided statistics on the diverse predictors of QoL in breast cancer patients. Still, the literature findings on the prognostication of QoL are scarce. Objectives: With this meta-analysis, we aim to describe the dynamics of overall QoL and its dimensions: mental status, physical functioning, and social interactions. Methods: To reach this aim, we will systematically evaluate the peer-reviewed literature on QoL of women who have undergone either mastectomy or breast-conserving surgery. The proposed study will focus on, but not be limited to, the analysis of BIRS, FACT-B, and EORTC QLQ-C30 questionnaires, which are most commonly used in the assessment of the quality of life of cancer patients. Then, we will extract the following outcome measures: The participants' age, time since surgery, type of tumor removal procedure (mastectomy or breast-conserving surgery), breast reconstruction technique, mean value, and standard deviation in a QoL score. A random-effects model will then compute the pooled QoL and construct the trend lines for scores received from each diagnostic tool. The findings will be adjusted according to the reconstruction techniques and tumor removal surgery. Finally, we will model the QoL dynamics with a set of predictors identified in the extracted studies. Conclusions: The study findings may serve as a tool for stratifying female patients with breast cancer by the risk of significant reduction in QoL.

The psychological impacts of post-mastectomy breast reconstruction: a systematic review

Background

While it is often presumed that undergoing breast reconstruction (BR) after mastectomy has positive psychosocial effects, a comprehensive review of current knowledge on the topic is to date absent. The aim of this systematic review is to summarize the available literature on the effects of BR on postoperative psychological distress.

Methods

A systematic review of the literature was performed using PubMed, Google Scholar, EMBASE, PSYCinfo, and Web of Science. Inclusion criteria included clinical studies of patients who underwent BR post-mastectomy with psychological distress assessments as primary outcomes. Articles were independently reviewed and assessed for bias and evidence quality. Analyses were performed among patients receiving mastectomy alone (MA) versus mastectomy with breast reconstruction (MBR), immediate versus delayed mastectomy, and implant-based versus autologous reconstruction.

Results

Ninety-nine studies published from 1980-2021 met inclusion criteria and were reviewed. Twenty-six (26.3%) studies compared patients who underwent MBR to those who underwent MA. Of these, 18 (69.2%) found that MBR had superior effects on psychologic outcomes, 6 (23.1%) found no differences, and 2 (7.7%) found negative psychologic effects relative to MA. Fourteen (14.1%) studies compared immediate versus delayed BR, of which 4 (28.6%) found that immediate BR had superior psychologic outcomes while 10 (71.4%) found no significant differences. Sixteen (16.2%) studies compared autologous versus implant-based reconstruction. Eight (50.0%) of these reported patients with autologous BR were more satisfied with breast appearance.

Conclusions

While findings are not uniform, the majority of studies found that BR following mastectomy improves psychologic outcomes, with a possible benefit of immediate over delayed BR. Future studies should determine if BR type has an effect on psychological distress.

Assessing quality of life and depression in non-metastatic breast cancer patients following surgical treatment: A cross-sectional study in Lebanon

Breast cancer is a global health concern that significantly impacts the quality of life (QOL) of individuals. This study aims to comprehensively examine the interplay between QOL and depression among nonmetastatic breast cancer patients in Lebanon, a region with limited research in this context. A cross-sectional study was conducted at Hammoud Hospital-University Medical Center from January 2018 to January 2023. Data was collected through a self-administered questionnaire distributed as Google Forms via WhatsApp. A total of 193 patients had non-metastatic breast cancer. Out of these, 81 valid responses were obtained. The Patient Health Questionnaire and Quality of Life Scale were used to assess depression and QOL, respectively. A total of 81 patients were included with mean age 54.4 years. Results revealed that 77.8% of patients experienced provisional depression, with 35.8% meeting criteria for major depressive disorder. Financial status and chronic diseases were associated with the likelihood of developing major depressive disorder. The mean QOL score was 81.14, lower than the average for healthy individuals. Educational level and presence of chronic diseases were significant factors influencing QOL. Postsurgical depression prevalence is substantial, underscoring the importance of integrating mental health care. Economic status and comorbidities are influential factors, necessitating targeted interventions. Breast cancer's impact on QOL is profound, falling below that of other chronic conditions. Education empowers coping, while comorbidities impact QOL. Our findings emphasize the multidimensional nature of breast cancer care, advocating for holistic support and addressing emotional well-being.

Investigation of symptom management and functional state of women who underwent breast cancer surgery

OBJECTIVE

The aim of this study was to investigate the symptom management and the functional status of women who underwent surgery for breast cancer.

METHODS

This cross-sectional descriptive study was conducted in a university hospital surgical oncology clinic. This study was conducted on 80 patients who had undergone breast cancer surgery in the last 5 years in a surgical oncology clinic of a university hospital. Study data were collected using the patient identification form, Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer, and Functional Living Index-Cancer. The data were analyzed with the SPSS program.

RESULTS

The mean total score of Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer was found to be 157.28±36.86, and the mean total score of the Functional Living Index-Cancer was found to be 103.79±18.77. When the correlation between the Functional Living Index-Cancer and Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer scales used in the study was examined, it was determined that there was a positive statistically significant correlation (p<0.05) between the subscale and scale total scores.

CONCLUSION

As a result of the study, it was determined that the self-efficacy and functional status of the patients were poor. Their functional status was also determined to be improved as the symptom self-efficacy levels increased.

Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs.

METHODS

MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively.

RESULTS

The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted.

CONCLUSIONS

Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.

Quality of life among French breast cancer survivors in comparison with cancer-free women: the Seintinelles study

BACKGROUND

Health-Related Quality of life (HRQoL) in cancer survivors can be significantly affected in the long-term by various consequences resulting from differing levels of severity of cancer and its treatments. Our objective was to identify factors associated with HRQoL in breast cancer survivors (BCSs) and cancer-free women (CFWs).

METHODS

We conducted a cross-sectional study in Seintinelles volunteers who answered online questionnaires between September 15, 2020 and February 5, 2021. HRQoL was measured using the World Health Organization Quality of Life-BREF questionnaire. We collected data on sociodemographic and health-related factors, lifestyle habits, coping mechanisms, locus of control, and health literacy. SAS version 9.4 statistical software was used for analyses. We performed descriptive analyses of the characteristics of the participants in each group and compared these characteristics between the two groups using the Chi2 test or the Student t-test. The adjusted means of the scores of different psychometric scales were calculated and compared using the method of least squares to fit general linear models (GLM) while adjusting for various factors. Multiple linear or multiple logistic regression models were used to assess the factors associated with WHOQOL-BREF scores, separately, in the two groups of participants.

RESULTS

The study involved 722 BCSs and 1359 CFWs aged 26-75 years. BCSs had significantly lower physical health scores and were less likely to be satisfied with their health compared to CFWs (59.5 vs. 63.2, p < 0.0001; and 56.5% vs. 75.2%, p = 0.002, respectively). In both groups, some common factors were positively associated with physical health (high financial level, being professionally active, normal BMI, good health status, alcohol consumption, higher values (> 22) of internal locus of control); or inversely associated (neurological and sleep problems, over two medical consultations/year). In BCSs, treatment by mastectomy or radiation therapy/brachytherapy, a short-time since diagnosis, current cancer therapy, and presence of sequalae were inversely associated with physical health. BCSs' health satisfaction was diminished with lower values of coping by positive thinking (≤ 14) and seeking social support (≤ 18).

CONCLUSIONS

HRQoL can be improved by developing strategies that increase internal locus of control and coping (positive thinking, problem-solving and seeking social support), and through health literacy.

The Effectiveness of an Upper Limb Rehabilitation Program on Quality of Life in Breast Cancer Patients after Mastectomy: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of an upper limb rehabilitation program on the quality of life in patients who had been first diagnosed breast cancer and subsequently underwent mastectomy.

DATA SOURCES

This randomized controlled trial enrolled 48 breast cancer patients who underwent mastectomy at a medical center in Taiwan. The patients were randomly assigned to either the intervention group (n = 24) or control group (n = 24). The patients in the intervention group participated in a 12-week upper limb rehabilitation program involving face-to-face upper limb rehabilitation education and once-a month monitoring of their upper extremity activity. The control group received standard nursing care. Quality of life was assessed through EORTC QLQ-C30 and QLQ-BR 23 questionnaires at baseline and weeks 4, 8, and 12 after enrollment.

RESULTS

Both the intervention and control groups had significantly improved their levels of functioning, symptoms, and quality of life from baseline to week 12 after enrollment. The intervention group showed greater improvements in functioning and symptom levels after the intervention compared to the control group; however, no statistically significant differences were found. Additionally, the levels of global health status/quality of life in both groups gradually increased from baseline to week 12 CONCLUSION: An upper limb rehabilitation program is effective in improving the functioning and symptoms of breast cancer patients who have undergone mastectomy.

IMPLICATIONS FOR NURSING PRACTICE

Patients are encouraged to undergo upper limb rehabilitation in order to improve their functioning, symptoms and quality of life.

Quality of Life in Breast Cancer Survivors in Relation to Age, Type of Surgery and Length of Time since First Treatment

(1) Background: Quality of life assessment is a critical aspect of breast cancer patient outcomes, as diagnosis, prognosis and treatment can have a major impact on quality of life. The aim of this study was to describe the characteristics of the sample and to verify the relationship between quality of life (QOL) in women diagnosed with breast cancer (BC) and their age, type or surgery and time since treatment; (2) Methods: a cross-sectional, descriptive study was conducted with 183 women diagnosed with BC, aged 30−80 years in Mexico. Women’s QOL was assessed using two questionnaires, The European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire (EORTC QLQ-C30) and The Breast Cancer Module (EORTC QLQ-BR23). (3) Results: the results show significant differences in several items when the variable age is taken into account, indicating that younger women have poorer social and sexual function, as well as poorer sexual enjoyment and lower expectations of the future. The type of surgery also indicates a significantly better QOL in those women who receive conservative treatment versus a mastectomy; the time elapsed since surgery does not show any significant results, except for sexual functioning and breast-related symptoms where >5 years implies better scores on the items. (4) Conclusions: in conclusion, it is important to take into account the characteristics of women with BC, particularly at the time of treatment, in order to mitigate the impact of the disease on their QOL with the help of a multidisciplinary team.

Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.