ORIGINAL ARTICLEQuality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study☆
Introduction
Breast cancer is the most common cancer in Swedish women.1 Despite advances in conservative surgery, mastectomy with or without axillary clearance is the recommended surgical treatment option in many situations. These include multifocal tumours or ductal cancer in situ (DCIS) lesions and large or locally advanced tumours. As reported in several studies, the loss of a breast is a psychologically traumatic event for many women.2, 3 An increasing number of women wish for reconstruction of the lost breast, and methods for immediate and delayed breast reconstructions have been developed. Since the goal of reconstruction is to improve well-being in mastectomised women, it is important to evaluate what impact such reconstructive surgery has on quality of life. It is also important to assess patient satisfaction as a measurement of quality of care and to understand what expectations women have of the procedure. Most studies that have addressed these issues have used a retrospective and cross-sectional design.4 There is a lack of prospective studies evaluating psychosocial issues relating to immediate breast reconstruction. The aims of this study were to examine the reasons women gave for undergoing immediate breast reconstruction, to determine general and aesthetic satisfaction with the results of reconstruction 1 year after surgery, and to assess the impact on quality of life using a validated measure of health outcomes. Responses were compared with those in an age-matched reference population.
Section snippets
Study population
The study population was made up of 76 consecutive patients diagnosed with breast cancer who underwent mastectomy followed by immediate breast reconstruction between August 1998 and July 2001 at the Karolinska Hospital. An expander/implant prosthesis was used in all cases. All patients were assessed by a multidisciplinary team, as described elsewhere.5
The median age of these patients was 46 years (range 25–71). The indication for surgery was cancer in situ in 17 women and invasive breast cancer
Health-related quality of life
The mean preoperative and 1-year postoperative SF-36 scores are shown in Table 2. Figure 1 illustrates the patients’ SF-36 health profiles compared with those in the age-matched reference population before and 1 year after surgery. The patients’ preoperative scores for the four scales primarily measuring emotional well-being and for physical role functioning (RP) were all significantly lower than those of the reference population. One year postoperatively there was a significant improvement in
Discussion
In this study 76 women were asked preoperatively and 1 year postoperatively to complete a questionnaire assessing their quality of life, expectations of reconstruction and outcome satisfaction. At the time of the first questionnaire, the SF-36 scores for physical and emotional role functioning, social functioning, vitality and mental health were all significantly lower than those for the normal population. This was expected, since these women were recently diagnosed with breast cancer and about
Acknowledgements
We thank all patients who completed questionnaires. We also thank Associate Professor Edwin G. Wilkins at the University of Michigan Hospitals for his help and for permission to translate parts of the MBROS questionnaire, Dr. Bo Nilsson for statistical review and Dr. Grahame Elder for valuable comments.
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This study was supported by grants from the King Gustaf V Jubilee Fund, the Swedish Cancer Society Stockholm (00138, 00182) and Fredrik and Ingrid Thuring Foundation.