Impact of surgery and chemotherapy on the quality of life of younger womenwith breast carcinoma - A prospective study

BACKGROUND. Studies that prospectively and simultaneously evaluate, within the first year of diagnosis, the impact of surgery and chemotherapy on qual ity of life (QOL) of younger women (60 years or younger) with early stage b reast carcinoma are limited. METHODS. Quality of life of 103 women who had surgery (lumpectomy, 49; mast ectomy, 54) approximately 1 month before the start of the study was evaluat ed at baseline and again after 5 months. Thirty-two women received chemothe rapy during the study. RESULTS. Over time, subjects reported improvement in body image and physica l, emotional, and functional well-being (P < 0.001). They were less bothere d by swollen/tender arms and worried less about risk of cancer to family me mbers (P < 0.001). However, satisfaction with sex life, social support, and social/family well-being declined (P < 0.001). In the period closer to sur gery, women with mastectomy reported poorer body image (P = 0.001) and wors e functional (P = 0.08) and physical well-being (P = 0.10). Women with lump ectomy worried more about the effects of stress on their illness (P < 0.01) and had lower emotional well-being (P = 0.06). By 6 months after surgery, the two groups reported similar QOL scores. Chemotherapy had a negative imp act on women's sexual functioning (P = 0.01) and their physical well-being (P = 0.09). Women who received chemotherapy also reported more shortness of breath (P = 0.07). Post hoc analysis showed that women with breast reconst ruction had higher emotional well-being at baseline than those with lumpect omy (P = 0.001) and mastectomy alone (P < 0.01). CONCLUSIONS. Younger women with breast carcinoma could experience a range o f adjustment problems at various points in the treatment cycle. Interventio ns that would help reduce the negative impact of treatment on QOL need to b e designed and integrated into routine clinical practice. (C) 2001 American Cancer Society.