INFLUENCE OF AGE AND OF DIFFERENT OPERATIVE METHODS ON THE QUALITY-OF-LIFE IN PATIENTS WITH BREAST-CANCER

Background: Diagnosis of breast cancer causes great psychological stre ss. In addition to the fact that the patient is suffering from a life- threatening disease, she is confronted with a possible amputation of t he breast. The female breast has a lot of real and symbolic significan ce for motherhood and femininity, and if one includes erotic and cosme tic aspects it is easy to see why its loss is perceived as a serious d amage to femininity and sex appeal. The advent of breast-conserving su rgery as an option has aroused many hopes of removing most of the psyc hological stress from the patients and improving their quality of life . Patients and Methods: Within the framework of this study the quality of life of women with primary breast cancer was investigated in depen dence on their age and the nature of the operation. 27 women who had a breast-conserving operation and 81 who had a modification of Patey's radical mastectomy were included in the study. 42 women in the latter group were under 60 years of age and the other 39 women were over 60. There were no significant differences in the description of the groups of patients, with the exception of the postoperative follow-up time, which was an average shorter in the patients who had the breast-conser ving operation: 2.01 years compared to 2.84 years after mastectomy. Th e patients were all assessed with the Karnofsky index which was above 50%. Two questionnaires were used: one of them was developed by a Mann heim Working group, the other was a validated test instrument of a Dut ch working group under Mrs. de Haes. The chi-square test was used for significance tests. The following areas of quality of life were invest igated: emotional stress, functional status and physical symptoms, fam ily and social contacts, sexuality, body image and femininity. Additio nal points looked at were information on the disease, attitude to self -help groups, and an overall assessment of the quality of life. Result s: Women who had had a mastectomy felt significantly more often that t hey were less attractive physically than before the operation, and mor e often developed the feeling of incomplete womanhood. The older woman also suffers from reduced physical attractiveness and the feeling of incomplete womanhood. When ages were compared, there was significantly more often a poorer overall assessment of the quality of life and a p oorer functional status and Karnofsky index after the mastectomy in th e group over 60 years. In all other areas (emotional stress, social co ntacts, sexuality and body image) there were no significant age-depend ent differences. Conclusions: This study throws new light on the quest ion to what extent the breast-conserving procedure is advantageous to older women. We found that older women after mastectomy suffer as much from the loss of a breast as younger women, i.e. they develop exactly the same feeling of no longer being a whole woman. The above results contradict statements by many authors who favor the breast-conserving procedure for younger women, and who question the benefit of this proc edure for older or old women. This result argues for including older p atients as well in the decision about the surgical procedure.