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Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up

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Abstract

Background

Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period.

Methods

Women with major BC surgeries were invited to complete the World Health Organization Quality of Life–Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.

Results

After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibited a high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8 years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC.

Conclusion

The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5 years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

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Data availability

The database data used and analyzed during the current study are not publicly available due to confidentiality and regulations regarding personal electronic data protection but are available from the corresponding author after approval from the IRB of the National Cheng Kung University Hospital.

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Acknowledgements

I am especially indebted to the National Cheng Kung university to support funding for my studies. Also, I wish to express my appreciation for those who had helped with the English editing of the manuscript.

Funding

The collection of patient’s reported outcome data was supported by serial grants from the Ministry of Science and Technology (MOST 108-2627-M-006-001, MOST 109-2621-M-006-007, MOST 110-2627-M-006-010). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC

    Sriyani Padmalatha Konara Mudiyanselage, Yi-Lin Wu, Chang-Chun Chen, Yi-Tseng Tsai & Han-Chang Ku

  2. Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC

    Yi-Lin Wu, Su-Ying Fang & Nai-Ying Ko

  3. Department of Public Health, College of Medicine, National Cheng Kung University, No.1, Ta-Hsueh Road, Tainan, 701, Taiwan, ROC

    Shikha Kukreti, Chia-Ni Lin, Jung-Der Wang & Nai-Ying Ko

  4. Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Su-Ying Fang & Nai-Ying Ko

  5. Operation Theatre Department, The National Hospital of Sri Lanka, Colombo, Sri Lanka

    Sriyani Padmalatha Konara Mudiyanselage

  6. No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan

    Yi-Tseng Tsai & Han-Chang Ku

  7. Department of Public Health College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan

    Shikha Kukreti & Jung-Der Wang

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  1. Sriyani Padmalatha Konara Mudiyanselage
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Contributions

Conceptualization: SPKM, N-YK, J-DW, S-YF; methodology: SPKM, N-YK, J-DW, S-YF; formal analysis and investigation: SPKm, SK, Y-LW, CCC, C-NL. Writing—original draft preparation: SPKM; writing—review and editing: H-CK, Y-TT, SK, N-YKJ-DW, S-YF; funding acquisition: SPKM, N-YK, J-DW; resources: SPKM, N-YK; supervision: N-YK, J-DW, S-YF.

Corresponding author

Correspondence to Nai-Ying Ko.

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The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by The Institutional Review Board of the National Cheng Kung University Hospital before initiation (review No: B-ER-110–050).

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Informed consent was obtained from every patient before adding the data to the database.

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Konara Mudiyanselage, S.P., Wu, YL., Kukreti, S. et al. Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up. Breast Cancer 30, 226–240 (2023). https://doi.org/10.1007/s12282-022-01413-6

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