Publications

Breast cancer is the most common cancer among females worldwide, of whom more than 80% survive for more than 5 years. Hence, ensuring a good quality of life (QOL) is essential to achieve holistic approach in treating patients. A cross-sectional study was conducted to compare the QOL in women who underwent modified radical mastectomy (MRM) and breast conservation surgery (BCS) for breast cancer in the last 5 years. QOL was evaluated based on the long-term quality of life–breast cancer (LTQOL–BC) questionnaire. A greater percentage of women who underwent MRM complained of difficulty in completing their house work compared with the BCS group (50% compared with 31%). Twenty-five percent (6) of the women who had undergone MRM reported feeling of being incomplete as women, along with a lack of femininity. However, more than 80% of the women in both groups said that they felt stronger as survivors and derived strength from their experience. There were significant differences in the quality of life of women from both groups in terms of physical function and body image, with the BCS group appearing to have a better QOL.

Keywords: Quality of life, Breast cancer, Modified radical mastectomy, Breast conservation surgery

Introduction

Breast cancer ranks 2nd, affecting almost a quarter of cancer patients [1]. Published reports from different cancer registries in India indicate rising trends in breast cancer incidence [2–6]. With the help of increased early detection and improved treatment, more than 80% of breast cancer patients survive for 5 years beyond diagnosis [7].

Background

Cancer is a chronic disease that has physical inadequacies and psychological problems, which is in periods of remissions and exacerbations. The WHO defines the quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns [8]. Various studies have evaluated differences in quality of life according to the method of breast cancer surgery. In many cases, breast-conserving surgery (BCS) presented a higher quality of life compared with modified radical mastectomy (MRM) [7, 9–15]. Using QLQ-BR23, independent factors improving the functional scales included BCS, higher level of education and marital status (married); in another study, independent factors improving symptoms were BCS, higher level of education, younger age and low and normal body mass index (BMI) [15]. In another study, among 407 patients, those with reconstruction after total mastectomy had better sexual scale and arm symptoms than those with only total mastectomy on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire breast cancer–specific module [7]. Of the 109 patients prospectively followed up, they found that after mastectomy, they had difficulties with clothing and body image; however, they concluded that these did not affect the assessment of mood or quality [11]. Women with prominent breast asymmetry were significantly more likely to feel stigmatized as a result of their breast cancer treatment (odds ratio (OR) = 4.58, 95% CI 2.77 to 7.55). Another conclusion was that women with pronounced breast asymmetry were more likely to exhibit depressive symptoms (minimal asymmetry, 16.2%; moderate asymmetry, 18.0%; pronounced asymmetry, 33.7%, Wald’s test = 16.6; p = 0.002) [13]. Among the elderly, it was found that those undergoing tumour excision and tamoxifen did not differ from those undergoing mastectomies in terms of fatigue, emotional functioning, fear of recurrence, social support, physical functioning and leisure time activities [14]. Survival rates with BCS are similar to mastectomy [16]. However, patients may be dissatisfied with their physical appearance and experience a lack of self-confidence, among other psychological issues. Our aim in this study was to analyse the difference, if any, in the quality of life of women following either MRM or BCS, in the setting of a tertiary hospital of India. The information obtained may contribute to optimal healthcare and better cooperation between patients and health care professionals.