Influence of Age and of Different Operative Methods on the Quality of Life in Patients with Breast Cancer

Abstract

Background: Diagnosis of breast cancer causes great psychological stress. In addition to the fact that the patient is suffering from a life-threatening disease, she is confronted with a possible amputation of the breast. The female breast has a lot of real and symbolic significance for motherhood and femininity, and if one includes erotic and cosmetic aspects it is easy to see why its loss is perceived as a serious damage to femininity and sex appeal. The advent of breast-conserving surgery as an option has aroused many hopes of removing most of the psychological 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 dependence 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-conserving operation: 2.01 years compared to 2.84 years after mastectomy. The patients were all assessed with the Karnofsky index which was above 50%. Two questionnaires were used: one of them was developed by a Mannheim Working group, the other was a validated test instrument of a Dutch working group under Mrs. de Haes. The chi-square test was used for significance tests. The following areas of quality of life were investigated: emotional stress, functional status and physical symptoms, family and social contacts, sexuality, body image and femininity. Additional points looked at were information on the disease, attitude to self-help groups, and an overall assessment of the quality of life. Results: Women who had had a mastectomy felt significantly more often that they were less attractive physically than before the operation, and more 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 poorer functional status and Karnofsky index after the mastectomy in the group over 60 years. In all other areas (emotional stress, social contacts, sexuality and body image) there were no significant age-dependent differences. Conclusions: This study throws new light on the question 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 ...

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

“…(2008) reported body image to be lower in younger patients after a mastectomy. However, others found no difference in body image related to age (Neises et al. 1994; Armer & Stewart 2005).…”

“…Engel et al 2004), and Helms et al (2008 reported body image to be lower in younger patients after a mastectomy. However, others found no difference in body image related to age (Neises et al 1994;Armer & Stewart 2005). Identifying which patients are most in need of counselling to minimise low self-esteem and body image would be an area for further research consideration.…”

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