Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up

Sriyani Padmalatha Konara Mudiyanselage; Yi-Lin Wu; Shikha Kukreti; Chang-Chun Chen; Chia-Ni Lin; Yi-Tseng Tsai; Han-Chang Ku; Su-Ying Fang; Jung-Der Wang; Nai-Ying Ko

doi:10.1007/s12282-022-01413-6

Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up

Breast Cancer. 2023 Mar;30(2):226-240. doi: 10.1007/s12282-022-01413-6. Epub 2022 Nov 1.

Authors

Sriyani Padmalatha Konara Mudiyanselage^{1

2}, Yi-Lin Wu^{1

3}, Shikha Kukreti^{4

5}, Chang-Chun Chen¹, Chia-Ni Lin⁴, Yi-Tseng Tsai^{1

6}, Han-Chang Ku^{1

6}, Su-Ying Fang^{3

7}, Jung-Der Wang^{4

5}, Nai-Ying Ko^{8

9

10}

Affiliations

¹ International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.
² Operation Theatre Department, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
³ Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.
⁴ Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC.
⁵ Department of Public Health College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan.
⁶ , No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan.
⁷ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC. nyko@mail.ncku.edu.tw.
⁹ Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC. nyko@mail.ncku.edu.tw.
¹⁰ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan. nyko@mail.ncku.edu.tw.

PMID: 36319889
DOI: 10.1007/s12282-022-01413-6

Abstract

Background: Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period.

Methods: Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.

Results: After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC.

Conclusion: The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

Keywords: Body image; Breast cancer survivors; Breast reconstruction; Mastectomy; Modified radical mastectomy; Psychological status; Quality of life.

MeSH terms

Body Image
Breast Neoplasms* / surgery
Female
Follow-Up Studies
Humans
Mammaplasty* / methods
Mastectomy / methods
Quality of Life / psychology
Surveys and Questionnaires