Mastectomy may affect psychosocial health and quality of life in women after surgery: JAMA

USA: Oncologic outcomes after breast cancer surgery in young women, greatly affect the quality of life (QOL) however association of surgery with longer-term satisfaction and QOL in young breast cancer survivors remains unknown. A recent cross-sectional study by Dr. Laura Dominici, MD, and team, reveals that unilateral or bilateral mastectomy with radiotherapy against breast-conserving therapy was associated with decreased breast satisfaction and psychosocial and sexual well-being. The findings of this study are published in JAMA Surgery. 

The objective of the study was to examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors.

The study was a multicenter cross-sectional study of a prospective cohort conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed during a 1- to the 2-year period after the conclusion of the study. Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain.

A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 with stage 0-II disease) completed the BREAST-Q a median of 5.8 years from diagnosis.

A total of 290 patients (52%) of patients underwent a bilateral mastectomy, 110 patients (20%) underwent a unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy.

The results of the study were:

• Among mastectomy patients, 357 (89%) had reconstruction, and 181 (45%) received radiotherapy.

• In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = −7.4) and complex reconstruction (vs autologous) with worse physical well-being (β = −14.0).

Dr. Dominici and their team efforts revealed that local therapy in young breast cancer survivors was persistently associated with poorer scores in multiple QOL domains, it was seen particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. They also stated that Socioeconomic stressors also appeared to play a role in the quality of life.

Reference:

Dominici L, Hu J, Zheng Y, et al. Association of Local Therapy With Quality-of-Life Outcomes in Young Women With Breast Cancer. JAMA Surg. 2021;156(10):e213758. doi:10.1001/jamasurg.2021.3758