engleski

Impact of type of primary surgery on quality of life, anxiety, depression and body image in breast cancer patients receiving adjuvant treatment: a cross-sectional study

Introduction: Breast cancer is the leading cause of cancer-related death in women and a major public health issue in developed countries. Primary surgery is the key treatment modality for localized breast cancer and there has been a shift towards breast conservation over the last two decades. Robust evidence suggests the longstanding impact of type of primary surgery on health-related quality of life (QoL) and integral well-being of patients with breast cancer going through adjuvant oncologic treatment. The aim of this study was to compare QoL, anxiety (A), depression (D) and body image (BI) of breast cancer patients during different phases of adjuvant treatment with respect to type of primary breast surgery received. Patients and methods: A total of 425 breast cancer patients were recruited in a cross-sectional study at key points of their adjuvant treatment trajectory: two weeks after primary surgery, during adjuvant chemotherapy, adjuvant radiotherapy, and at a 6-month follow-up. They completed pen-paper questionnaires, including the EORTC core questionnaire QLQ-C30 and breast cancer-specific module QLQ-BR23, Hospital Anxiety Depression Scale (HADS) and Body Image Scale. Differences in clinical and treatment factors and differences in mean scores across QoL domains, A, D, and BIS for all cohort and for each phase of adjuvant treatment were analyzed using chi square test, ANOVA or student t-test. Association of type of surgery with global QoL as the main QoL domain was explored using linear regression. Results: Two- hundred eighty-nine (69%) and 133 (31%) patients were treated with primary breast-conserving surgery (BCS) and mastectomy (M). With respect to baseline clinical and sociodemographic factors, significant differences between women with BCS and M were observed in tumor stage (p<0.0001), tumor grade (p=0.002), phase of adjuvant treatment (p<0.0001), and in comorbidity level (p=0.02). Patients with more advanced stage, higher tumor grade, patients receiving adjuvant chemotherapy, and patients with less comorbidity were more likely to undergo M as opposed to BCS. Furthermore, patients who had mastectomy had lower body image (higher scores on Body Image scale and body image at functional QLQ- BR23 scale) (both p=0.0001), while there were no significant differences in A, D, and other QoL scales. Analysis was repeated for each phase of adjuvant treatment (surgery, adjuvant chemotherapy, adjuvant radiotherapy, and 6-month follow-up post treatment). Again, apart from body image domains, no other scales were significantly different between patients who had BSC or M, respectively. Conclusions: These results show that type of primary surgery has no impact on QoL, anxiety, depression and is limited to the self-image of breast cancer patients. Therefore, mastectomy may not be perceived as a priory negative factor for QoL. However, we found it contributed to a worse body image in breast cancer patients. Limitations include a cross- sectional study design where heterogeneity between patient groups might have affected study results.

anxiety ; body image ; breast cancer ; depression ; mastectomy ; quality of life

nije evidentirano