Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation

in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image. EJSO -European Journal of Surgical Oncology, WB Saunders, 2010, 36 (8) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. To investigate and compare long-term health-related quality of life (HRQoL), body image, and emotional reactions in women with ductal carcinoma in situ of the breast (DCIS) treated with different surgical methods. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Patients and Methods:A total of 162 women were included in the study (47 had mastectomy and immediate breast reconstruction (IBR), 51sector resection alone and 64 sector resection and postoperative radiotherapy). All women included in the study were asked to complete three questionnaires 4-15 years after surgery: the SF-36 for HRQoL, the Hospital Anxiety and Depression (HAD) scale, and the Body Image Scale (BIS). The response rate was 81%. Results:Women in all three study groups had, overall, a very satisfactory HRQoL in the long term, similar to women in the general population. Women who underwent mastectomy and IBR scored significantly higher on physical functioning and bodily pain than the other two study groups as well as their age-adjusted norm groups. The addition of radiotherapy to breast-conserving therapy did not seem to have any negative impact on long-term HRQoL. Our results show significant differences between the three study groups for six of ten BIS items, with a greater proportion of women in the mastectomy and IBR group reporting problems. Conclusions:Women treated for DCIS have a very satisfactory long-term HRQoL. However, body image appeared to be negatively affected in mastectomy and IBR patients. Our results indicate that these women need more preoperative information about what changes in body image to expect after surgery.

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“…These findings are consistent with three other studies of long-term HRQoL among women with DCIS [16,25,26].…”

Section: Accepted Manuscript 9 DIsupporting

confidence: 92%

“…This is consistent with the only prior study that we could find evaluating the impact of radiation therapy on long-term HRQoL in women with DCIS [26]. However, women in the sector resection alone group scored higher on the mental health subscale than the other two study groups, probably reflecting less extensive treatment.…”

Section: Accepted Manuscript 9 DIsupporting

confidence: 89%

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

Sackey

Sandelin

Frisell

et al. 2010

European Journal of Surgical Oncology (EJSO)

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“…QL was assessed by a general QL module of 20 items which has been used as a part of a larger questionnaire in a previous study [13]and exploring most of the fields of interest in breast cancer QL assessment: physical well-being, physical autonomy, personal relationships and psychological well-being. On the basis of a factorial analysis, the items concurred to define four subscales which were scored by averaging the single item scores and linearly transforming the result to a 0–100 scale.…”

Section: Methodsmentioning

confidence: 99%

Pain after Quadrantectomy and Radiotherapy for Early-Stage Breast Cancer: Incidence, Characteristics and Influence on Quality of Life

Amichetti

Caffo²

2003

Oncology

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Purpose: Conservative breast surgery (CBS) is viewed as a surgical technique able to improve the psychophysical outcome of women who underwent surgery for breast cancer (BC). CBS has clearly improved the impact of local treatment on postoperative body image adjustment, but the effect on patients’ quality of life (QL) is similar to that observed after mastectomy. This insufficient adjustment may be related to the fact that sensorial alterations, mainly pain, may produce negative effects on patients’ QL. This retrospective study, based on self-completed questionnaires, reports the patients’ descriptions of pain and its relationships with QL adjustment after quadrantectomy and radiotherapy for BC. Patients and Methods: We mailed a questionnaire to a consecutive series of 481 patients treated with CBS and radiotherapy from March 1995 to March 1998. The questionnaire, listing 129 items, comprised: (1) a pain assessment module with the short form of the McGill Pain Questionnaire exploring the characteristics and the description of the pain; (2) a QL questionnaire including four subscales (physical well-being, psychological well-being, physical autonomy, and relationships). Results: Three hundred and forty-eight patients (72%) completed the questionnaire, but 24 were excluded from the analysis due to absence of axillary dissection. One hundred and forty-one patients reported pain as a consequence of treatment. It generally started within 3 months after the completion of therapy, was localized in the axillary region and was intermittent. The pain was mainly described as aching (59%), tender (51%) and cramping (43%). Compared to the patients who did not experience pain, those who suffered from pain had significantly worse scores in physical (p < 0.0001), psychological (p < 0.0001), autonomy (p < 0.05), and relational subscales (p < 0.0001). Conclusions: Our data support the hypothesis that pain is a frequent sequela of CBS and radiotherapy, and that such symptoms can cause postoperative psychosocial distress, thus limiting patient adaptation and reducing the beneficial effect of CBS on body image.

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“…Although quality of life of women with DCIS has been studied [6][7][8][9][10][11] and compared to quality of life of women with invasive disease in two studies [12,13], quality of life of these two groups of women was never compared at multiple points during the treatment trajectory. Our aim was to prospectively compare women diagnosed with DCIS to women with invasive breast cancer who had had or did not have chemotherapy, separately, in terms of psychological distress and health-related quality of life during the first year after treatment initiation.…”

Section: Introductionmentioning

confidence: 99%

Psychological distress and physical health in the year after diagnosis of DCIS or invasive breast cancer

Lauzier

Maunsell

Lévesque

et al. 2009

Breast Cancer Res Treat

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Ductal carcinoma in situ (DCIS) has an excellent prognosis, but its management can resemble that of early invasive breast cancer. We compared aspects of quality of life of women with DCIS to that of women with invasive disease during the first year after treatment initiation. Participants came from consecutive series of women with newly diagnosed, non-metastatic breast cancer treated in eight Quebec hospitals in 2003. Psychological distress and health-related quality of life were measured using the Psychiatric Symptom Index (PSI) and the SF-12 mental and physical component scales (MCS, PCS). Data were obtained 1, 6, and 12 months after the start of treatment. We used generalized linear models to compare mean scores and explored the possible clinical significance of between-group differences with effect size (ES). Participation and retention among eligible women were high, 86 and 97%, respectively. Among the 800 women who completed all interviews, 13.4% (n = 107) had DCIS and 86.6% (693) invasive disease. No statistically significant between-group differences were found at 1, 6, or 12 months in psychological state (PSI and MCS: P values from 0.065 to 0.904; ES from -0.01 to -0.21). Women with DCIS reported significantly higher levels of physical health, particularly when compared at 1 month to women with invasive disease who had chemotherapy (P value < 0.0001; ES = 0.82). Measured in symptoms of psychological distress, the better prognosis or less aggressive management of DCIS does not offset the general psychological effects of a cancer diagnosis to any great degree.

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Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation

Abstract: This study revealed a good QL in patients treated with breast conservation and postoperative irradiation, with a preserved favourable body image and a lack of negative impact on sexuality. Radiation therapy did not lead to any significant additional problems capable of affecting the QL.

Cited by 30 publications

References 47 publications

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image

Pain after Quadrantectomy and Radiotherapy for Early-Stage Breast Cancer: Incidence, Characteristics and Influence on Quality of Life

Psychological distress and physical health in the year after diagnosis of DCIS or invasive breast cancer

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