Women Who Undergo Delayed Breast Reconstruction May Experience More Cancer‑Related Distress Than Women Who Undergo Mastectomy Alone
In women who have undergone mastectomy, those who underwent delayed breast reconstruction experienced greater cancer-related distress over the long term compared with women who underwent mastectomy alone, according to a prospective study by Metcalfe et al in the Journal of Surgical Oncology.
For women with breast cancer who undergo mastectomy, breast reconstruction may be an option. Whether a woman chooses mastectomy alone or immediate or delayed breast reconstruction depends on a number of issues, which both the patient and her surgeon need to discuss beforehand. Little is known as to whether there are differences, particularly related to psychosocial issues such as level of distress, between women with breast cancer who have mastectomy alone and those who undergo delayed breast reconstruction.
Metcalfe and colleagues conducted a prospective study to examine the psychosocial outcomes in women who had mastectomy alone compared to those who underwent breast reconstruction more than 1 year postmastectomy. Psychosocial functioning was assessed according to levels of total distress, obsessiveness, and cancer-related distress.
Study Details
Included in the study were 67 patients who were followed for a mean of 75.2 months (range = 56.3–107.3 months). Psychosocial function scores were assessed at three time points: premastectomy, 1-year postmastectomy, and long-term postmastectomy (mean = 6.3 years).
Of the 67 women, 28 (41.8%) underwent delayed breast reconstruction after the 1-year follow-up and before the long-term follow-up. The mean time between mastectomy and delayed breast reconstruction was 35.5 months. Demographic and clinical characteristics were similar among all of the women.
Cancer-Related Distress
At long-term follow-up, women who underwent delayed breast reconstruction had significantly higher levels of total distress (P = .01), obsessiveness (P = .03), and cancer-related distress (P = .02) compared with women who underwent mastectomy alone. Further, 39.3% of women who underwent delayed breast reconstruction experienced moderate or severe cancer-related distress at the long-term follow-up compared with 15.4% of women who underwent mastectomy alone.
There were no statistically significant differences in quality of life between women who underwent mastectomy alone and those who had delayed breast reconstruction.
Closing Thoughts
According to the investigators, psychosocial functioning improved over time in patients treated with mastectomy in the long-term breast cancer survivorship period, which may be related to the effect of time posttreatment and not whether or not these women chose to undergo delayed breast reconstruction. Over the course of the study, the investigators did not observe any statistically significant differences in changes in quality of life over time as a result of having mastectomy alone or delayed breast reconstruction.
“It is critical for health-care providers to recognize that women who seek out delayed breast reconstruction may have higher baseline levels of distress and body image issues postmastectomy, which may persist after delayed breast reconstruction,” the authors said.
Kelly A. Metcalfe, RN, PhD, Professor at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada, is the corresponding author of this article in the Journal of Surgical Oncology.
Research for this study was supported by the Canadian Breast Cancer Foundation. The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
