Quality of life influenced by primary surgical treatment for stage I-III breast cancer - Long-term follow-up of a matched-pair analysis

Background: Breast-conserving therapy has been demonstrated to be just as s afe and a less disruptive experience compared with mastectomy for surgicall y manageable breast cancer. There is, however, no agreement in the literatu re about the impact of these procedures on several important aspects of qua lity of life (QOL). The purpose of the present study is to compare the long -term impact of these two surgical approaches on QOL in patients with ident ical tumor stages and to suggest possible shortcomings of the standard QOL questionnaires. Method: Between August 1999 and May 2000, QOL questionnaires were answered by 152 pair-matched patients at the I. Frauenklinik, Ludwig-Maximilians Uni versity Munich, as part of routine follow-up examinations. The pairs of pat ients, each consisting of one patient after mastectomy and one after breast conservation, were selected according to the highest degree of equivalence in tumor stage. All patients had been initially treated for stage I-III br east cancer without evidence of distant metastases. The QOL was evaluated b y using the QLQ-C30 questionnaire version 2.0 of the EORTC Study Group on Q uality of Life. We formulated seven additional questions about the patients ' satisfaction with the primary surgical treatment modality as viewed from their current perspective. The QOL questionnaires were answered after a med ian interval of 46 months following primary treatment. Results: Tumor stage, prognostic factors, and adjuvant systemic treatment w ere well balanced between the two groups. No differences between the two gr oups were observed in terms of all QOL items measured by the QLQ-C30. Our a dditional questions, however, revealed that patients in the mastectomy grou p were less satisfied with the cosmetic result of their primary operation ( P <.0001), were more Likely to feel basic changes in their appearance (P <. 0001), and were more likely to be emotionally stressed by these facts (P <. 0001). From their perspective at the time of completing the questionnaires, 11 patients in the mastectomy group (15%) would decide differently about t he surgical treatment modality, compared with only 3 patients (4%) in the b reast conservation group (P =.025). Conclusion: While the primary surgical treatment modality seems to have no long-term impact on general QOL, certain body-image-related problems may be caused by mastectomy. Standard measuring instruments for QOL may fail to d etect differences in satisfaction and adaptation with the primary surgical treatment modality.