Breast conservation versus mastectomy: distress sequelae as a function of choice.
Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70% of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P less than .03). For example, they were significantly more distressed over time (F = 5.5, P less than .02), and more depressed in general (F = 9.2, P less than .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P less than .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when "choice" played a major role, the conservation patients were psychologically worse off--at least at 3-month's follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Levy
S M
SM
Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, PA 15213.
Herberman
R B
RB
Lee
J K
JK
Lippman
M E
ME
d'Angelo
T
T
D000339:Affect; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D002755:Choice Behavior; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000523:psychology*; D009367:Neoplasm Staging; D011446:Prospective Studies; D011581:Psychological Tests; D011897:Random Allocation