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Subtle Differences in Quality of Life After Breast Cancer Surgery

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Abstract

Background: Lumpectomy with axillary dissection (LAD) has taken its place alongside mastectomy (M) as the treatment of choice for stage I and II breast cancer. Its appeal is based on lessening disfigurement and thus improving quality of life.

Methods: We used the SF-36 Health Survey modified with ten questions relevant to breast cancer surgery to evaluate whether quality of life with LAD was better than with mastectomy in women with stage I and II disease. The additional questions addressed satisfaction with intimate relationships and sexuality, and explored impact on the way women dress, use bathing suits, hug people, are comfortable with nudity, and rate their sexual drive and sexual responsiveness.

Results: LAD was not associated with statistically significant better quality-of-life scores on any SF-36 questions, except vitality (P = .02). No differences were noted in the areas of intimacy and sexual satisfaction. LAD patients reported significant differences in matters of dress, use of bathing suits, hugging, comfort with nudity, and sexual drive compared to patients undergoing mastectomy.

Conclusions: The SF-36 health survey detected few differences in quality of life measures between patients with LAD and those with mastectomy. However, LAD impacts favorably on the way women dress, on comfort with nudity, and on sexual drive.

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REFERENCES

  1. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 1981;305:6–11.

    Article  PubMed  CAS  Google Scholar 

  2. Fisher B, Anderson S, Redmond C, Wolmark N, Wickerham DL, Cronin W. Reanalysis and results after 12 years follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation with the treatment of breast cancer. N Engl J Med 1995;333:1456–1461.

    Article  CAS  PubMed  Google Scholar 

  3. Abrams J, Phillips PH, Friedman MA. Meeting highlights: a reappraisal of research results for the local treatment of early stage breast cancer. J Natl Cancer Inst 1995;87:1837–1845.

    PubMed  CAS  Google Scholar 

  4. Fisher B, Dignam J, Mamounas E, et al. Sequential methotrexate and fluorouracil for the treatment of node negative breast cancer patients with estrogen receptor- negative tumors : eight-year results from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-13 and first report of the findings from NSABP B-19 comparing methotrexate and fluorouracil with conventional cyclophosphamide, methotrexate, and fluorouracil. J Clin Oncol 1996;14:1982–1992.

    PubMed  CAS  Google Scholar 

  5. Fisher B, Dignam J, Wolmark N, et al. Tamoxifen and chemotherapy for lymph node negative, estrogen receptor-positive breast cancer. J Natl Cancer Inst 1997;89:1673–1682.

    PubMed  CAS  Google Scholar 

  6. Consensus statement: treatment of early-stage breast cancer. NIH Consensus Development Conference, June 18–21, 1990, Bethesda, MD. Bethesda, MD: National Institutes of Health, 1990;8:1–19.

  7. Veronesi U, Banfi A, Salvadori B, et al. Breast conservation is the treatment of choice in small breast cancer: long term results of a randomized trial. Eur J Cancer 1990;26:668–670.

    Article  PubMed  CAS  Google Scholar 

  8. Sanger CK, Reznikoff M. A comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy. Cancer 1981;48:2341–2346.

    PubMed  CAS  Google Scholar 

  9. Steinberg MD, Juliano MA, Wise L. Psychological outcome of lumpectomy versus mastectomy in the treatment of breast cancer. Am J Psychiatry 1985;142:34–39.

    PubMed  CAS  Google Scholar 

  10. Ganz PA, Schag AC, Lee J, Polinsky M, Tan S. Breast conservation versus mastectomy: is the difference in psychological adjustment or quality of life in the year after surgery? Cancer 1992;69:1729–1738.

    PubMed  CAS  Google Scholar 

  11. de Haes JC, Welvaart K. Quality of life after breast cancer surgery. J Surg Oncol 1985;28:123–125.

    PubMed  CAS  Google Scholar 

  12. Pozo C, Carver CS, Noriega V, et al. Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol 1992;10:1292–1298.

    PubMed  CAS  Google Scholar 

  13. Fallowfield LJ, Baum M, Maguire GP. Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. BMJ 1986;293:1331–1334.

    Article  CAS  PubMed  Google Scholar 

  14. Jamison K, Wellisch DK, Pasnau RO. Psychosocial aspects of mastectomy. I: The woman’s perspective. Am J Psychiatry 1978;135:432–436.

    PubMed  CAS  Google Scholar 

  15. Psychological Aspects of Breast Cancer Study Group. Psychological response to mastectomy: a prospective comparison study. Cancer 1987;59:189–196.

    Google Scholar 

  16. Kemeny MM, Wellisch DK, Schain WS. Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer. Cancer 1988;62:1231–1237.

    PubMed  CAS  Google Scholar 

  17. Schover LR. Sexuality and body image in younger women with breast cancer. Monogr Natl Cancer Inst 1994;16:177–182.

    PubMed  Google Scholar 

  18. Schover LR, Yetman RJ, Tuason LJ, et al. Partial mastectomy and breast reconstruction. Cancer 1995;75:54–64.

    PubMed  CAS  Google Scholar 

  19. Ganz P, Coscarelli A, Fred C, Kahn B, Polinsky M, Petersen L. Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 1996;38:183–199.

    CAS  PubMed  Google Scholar 

  20. Schain W, Edwards B, Gorell C, et al. Psychosocial and physical outcomes of primary breast cancer therapy: mastectomy vs. excisional biopsy and irradiation. Br Cancer Res Treat 1983;3:337–382.

    Google Scholar 

  21. Lasry JM, Margolese RG, Poisson R. Depression and body image following mastectomy and lumpectomy. J Chronic Dis 1987;40:529–534.

    PubMed  CAS  Google Scholar 

  22. Ware JE. Conceptualizing disease impact and treatment outcomes. Cancer 1984;53:2316–2326.

    PubMed  Google Scholar 

  23. Stewart AL, Hays RD, Ware JE. The MOS Short-form General Health Survey. reliability and validity in a patient population. Med Care 1988;26:724–734.

    CAS  PubMed  Google Scholar 

  24. Tarlov AR, Ware JE, Greenfield S, Nelson E, Perrin E, Zubkoff M. The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA 1989;262:925–930.

    Article  CAS  PubMed  Google Scholar 

  25. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA 1989;262:907–913.

    PubMed  CAS  Google Scholar 

  26. Ware JE, Sherbourne CD. The MOS 36-Item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care 1992;30:473–483.

    PubMed  Google Scholar 

  27. McHorney CA, Ware JE, Rogers W, Raczek A, Lu JFR. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts: results from the Medical Outcomes Study. Med Care 1992;30:MS253–MS265.

    PubMed  CAS  Google Scholar 

  28. Ware J. SF-36 Health Survey Manual, and Interpretation Guide. Boston: The Health Institute, New England Medical Center Hospital, 1993.

  29. McHorney CA, Kosinski M, Ware JE. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care 32:551–567.

  30. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Economics 1993;2:217–227.

    PubMed  CAS  Google Scholar 

  31. Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision making. In: Walker SR, Rosser RM (eds). Quality of Life: Assessment and Application. Lancaster, UK: MTP Press Limited 1987:9–49.

    Google Scholar 

  32. Ganz P, Rowland J, Desmond K, Meyerowitz B, Wyatt G. Life after breast cancer: understanding women’s health related quality of life and sexual functioning. J Clin Oncol 1998;16:501–514.

    PubMed  CAS  Google Scholar 

  33. Vinokur AD, Threatt BA, Vinokur-Kaplan D, et al. The process of recovery from breast Cancer for younger and older patients. Cancer 1990;65:1242–1254.

    PubMed  CAS  Google Scholar 

  34. Mor V, Malin M, Allen S. Age differences in the psychological problems encountered by breast cancer patients. Monogr Natl Cancer Inst 1994;16:191–197.

    PubMed  Google Scholar 

  35. Norhouse L. Breast cancer in younger women: effects on interper-sonal and family relations. Monogr Natl Cancer Inst 1994;16:183–1890.

    Google Scholar 

  36. Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelnick H on behalf of the European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Quality of life of early stage breast cancer patients treated with radical mastectomy or breast conserving procedures: results of EORTC Trial 10801. Eur J Cancer 1998;34:307–14.

    PubMed  CAS  Google Scholar 

  37. Ganz PA, Day R, Ware JE, Redmond C, Fisher B. Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial. J Natl Cancer Inst 1995;87:1372–82.

    PubMed  CAS  Google Scholar 

  38. Ollila DW, Giuliano AE. Intraoperative lymphatic mapping and sentinel lymphadenectomy using isosulfan blue dye. Breast Diseases: A Year Book Quarterly 1998;8:297–300.

    Google Scholar 

  39. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998;16:2672–85.

    CAS  PubMed  Google Scholar 

  40. Carlson GW, Bostwick J, Styblo TM, Moore B, Fried JT, Murray DR, Wood WC. Skin-sparing mastectomy: oncologic and reconstructive considerations. Ann Surg 1997;225:570–8.

    PubMed  CAS  Google Scholar 

  41. Newman L, Kuerer HM, Hunt KK, et al. Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 1998;5:620–6.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey

    Irene L. Wapnir MD & Ronald P. Cody PhD

  2. Environmental and Occupational Health Science Institute, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey

    Ralph S. Greco MD

  3. Dept.of Surgery, UMDNJ-Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, P.O. Box 19, New Brunswick, NJ, 08903

    Irene L. Wapnir MD

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  1. Irene L. Wapnir MD
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  2. Ronald P. Cody PhD
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  3. Ralph S. Greco MD
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Wapnir, I.L., Cody, R.P. & Greco, R.S. Subtle Differences in Quality of Life After Breast Cancer Surgery. Ann Surg Oncol 6, 359–366 (1999). https://doi.org/10.1007/s10434-999-0359-y

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  • DOI: https://doi.org/10.1007/s10434-999-0359-y

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