Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study.
BACKGROUND
Studies that prospectively and simultaneously evaluate, within the first year of diagnosis, the impact of surgery and chemotherapy on quality of life (QOL) of younger women (60 years or younger) with early stage breast carcinoma are limited.


METHODS
Quality of life of 103 women who had surgery (lumpectomy, 49; mastectomy, 54) approximately 1 month before the start of the study was evaluated at baseline and again after 5 months. Thirty-two women received chemotherapy during the study.


RESULTS
Over time, subjects reported improvement in body image and physical, emotional, and functional well-being (P < 0.001). They were less bothered by swollen/tender arms and worried less about risk of cancer to family members (P < 0.001). However, satisfaction with sex life, social support, and social/family well-being declined (P < 0.001). In the period closer to surgery, women with mastectomy reported poorer body image (P = 0.001) and worse functional (P = 0.08) and physical well-being (P = 0.10). Women with lumpectomy worried more about the effects of stress on their illness (P < 0.01) and had lower emotional well-being (P = 0.06). By 6 months after surgery, the two groups reported similar QOL scores. Chemotherapy had a negative impact on women's sexual functioning (P = 0.01) and their physical well-being (P = 0.09). Women who received chemotherapy also reported more shortness of breath (P = 0.07). Post hoc analysis showed that women with breast reconstruction had higher emotional well-being at baseline than those with lumpectomy (P = 0.001) and mastectomy alone (P < 0.01).


CONCLUSIONS
Younger women with breast carcinoma could experience a range of adjustment problems at various points in the treatment cycle. Interventions that would help reduce the negative impact of treatment on QOL need to be designed and integrated into routine clinical practice.
Arora
N K
NK
Center for Health Systems Research and Analysis, University of Wisconsin, Madison, USA. aroran@mail.nih.gov
Gustafson
D H
DH
Hawkins
R P
RP
McTavish
F
F
Cella
D F
DF
Pingree
S
S
Mendenhall
J H
JH
Mahvi
D M
DM
D000223:Adaptation, Psychological; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001828:Body Image; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology; D015412:Mastectomy, Segmental / Q000523:psychology; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life
D000970:Antineoplastic Agents