title: The effects of type of surgery and time on psychological adjustment in women after breast cancer treatment.
abstract: BACKGROUND
  The aim of the present study was to examine whether type of surgery, age, and time since surgery influenced psychological distress and quality of life (QOL) in women treated for breast cancer.
  
  
  METHODS
  We surveyed 183 women who had undergone surgery for breast cancer. Psychological distress was measured with the Mental Health Inventory and QOL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.
  
  
  RESULTS
  After controlling for stage of disease, radiation treatment, and age, there was a statistically significant interaction between type of surgery and time since surgery for the Mental Health Inventory total score, and a marginal interaction between type of surgery and time since surgery for the Global health status/QOL score. Women who had breast conservation surgery experienced significantly greater levels of psychological distress and marginally worse QOL from 40 months after surgery onward than did women who received a mastectomy.
  
  
  CONCLUSIONS
  The effects of different surgical treatments for breast cancer on psychological distress and QOL become apparent only after a period of several years. Women, therefore, need counseling on the potentially positive and negative psychological implications of different surgical treatments for breast cancer.
authors.affiliation: Department of Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. lcohen@notes.mdacc.tmc.edu
authors.forename: L
authors.initials: L
authors.lastname: Cohen
authors.forename: T F
authors.initials: TF
authors.lastname: Hack
authors.forename: C
authors.initials: C
authors.lastname: de Moor
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: P E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D013315:Stress, Psychological; D016019:Survival Analysis; D013997:Time Factors