title: The choice for breast cancer surgery: can women accurately predict postoperative quality of life and disease-related stigma?
abstract: BACKGROUND
  To make an informed choice, breast cancer patients facing surgery must imagine the effect of surgery on their future life experiences. However, the accuracy of patient predictions of postoperative quality of life (QoL) and disease-related stigma is not well understood.
  
  
  METHODS
  Four groups of breast cancer patients at the University of Michigan Medical Center were surveyed by mail and interview (response rate 76.3%): (1) preoperative (N = 59), (2) mastectomy (N = 146), (3) mastectomy with reconstruction (N = 250), and (4) breast conservation (N = 705). Subjects rated their QoL (1 = lowest, 100 = highest) and stigma (1 = lowest, 5 = highest) and estimated QoL and stigma associated with mastectomy alone, mastectomy with reconstruction, and breast conserving surgery (BCS). Mean scores were compared using linear regression controlling for age, race, partnered status, and income.
  
  
  RESULTS
  Preoperatively, women inaccurately predicted postoperative QoL and stigma for all surgical options, particularly for mastectomy. Preoperative patients underestimated the postoperative QoL for mastectomy alone (predicted: 56.8 vs actual: 83.7; P < .001). Preoperative patients underestimated QoL following mastectomy following reconstruction (predicted: 73.4 vs actual: 83.9; P < .001) and BCS (predicted: 72.2 vs actual: 88.6; P < .001). Additionally, preoperative patients overestimated stigma related to mastectomy (predicted: 3.25 vs actual: 2.43; P < .001). Finally, preoperative women overestimated stigma related to mastectomy with reconstruction (predicted: 2.54 vs actual: 2.03; P < .001) and BCS (predicted: 1.90 vs actual: 1.76; P < .001).
  
  
  CONCLUSIONS
  Predicting QoL and stigma following breast cancer surgery is challenging for patients facing a diagnosis for surgery. Identifying strategies to better inform patients of surgical outcomes can improve the decision-making process.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA. filip@med.umich.edu
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Dunya M
authors.initials: DM
authors.lastname: Atisha
authors.forename: Emily S
authors.initials: ES
authors.lastname: Hu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011287:Prejudice; D011379:Prognosis; D011788:Quality of Life; D014930:Women / Q000523:psychology