Quality of life after breast carcinoma surgery - A comparison of three surgical procedures

BACKGROUND. Because breast-conserving surgery (BCS), mastectomy alone, and mastectomy with reconstruction are equally effective for the treatment of e arly stage breast carcinoma, women's choice among them often focuses on qua lity-of-life (QOL) issues. Information regarding QOL after these surgical t reatments could help women with this decision. METHODS. Participants in this prospective study were women, age 30-85 years , with newly diagnosed breast carcinoma who underwent BCS (n = 103), mastec tomy alone (n = 55), or mastectomy with reconstruction (n = 40). Quality of life was assessed after diagnosis (baseline) and at 1, 3, 6, 12, 18, and 2 4 months after baseline by using the Mischel Uncertainty in Illness Scale, Profile of Mood States, and Functional Assessment of Cancer Therapy for Bre ast Cancer. RESULTS, In multivariate regression analyses controlling for the QOL score obtained at baseline, age, and type of nonsurgical treatment, women who und erwent mastectomy with reconstruction had greater mood disturbance (P = 0.0 02) and poorer well-being (P,= 0.002) after baseline than women who had mas tectomy alone; these differences remained 18 months after surgery. Although similar analyses also showed that women who underwent BCS had more mood di sturbance than women who had mastectomy alone, this difference was signific ant only at 12 months after baseline. The BCS and mastectomy-only group did not differ significantly regarding well-being. CONCLUSIONS. Aspects of QOL other than body image are not better in women w ho undergo BCS or mastectomy with reconstruction than in women who have mas tectomy alone. In fact, mastectomy with reconstruction is associated with g reater mood disturbance and poorer well-being. (C) 2001 American Cancer Soc iety.