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The Choice for Breast Cancer Surgery: Can Women Accurately Predict Postoperative Quality of Life and Disease-Related Stigma?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

Materials and 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).

Conclusion

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.

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Author information

Authors and Affiliations

  1. Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan

    Jennifer F. Waljee MD, MPH, MS, Emily S. Hu MD & Amy K. Alderman MD, MPH

  2. Fuqua School of Business, Duke University, Durham, North Carolina

    Peter A. Ubel MD

  3. Sanford School of Public Policy, Duke University, Durham, North Carolina

    Peter A. Ubel MD

  4. Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina

    Dunya M. Atisha MD

Authors
  1. Jennifer F. Waljee MD, MPH, MS
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  2. Peter A. Ubel MD
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  3. Dunya M. Atisha MD
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  4. Emily S. Hu MD
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  5. Amy K. Alderman MD, MPH
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Corresponding author

Correspondence to Jennifer F. Waljee MD, MPH, MS.

Additional information

This work was conducted at the University of Michigan Medical Center and funded by the Robert Wood Johnson Foundation through the Robert Wood Johnson Clinical Scholars Program at the University of Michigan.

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Waljee, J.F., Ubel, P.A., Atisha, D.M. et al. The Choice for Breast Cancer Surgery: Can Women Accurately Predict Postoperative Quality of Life and Disease-Related Stigma?. Ann Surg Oncol 18, 2477–2482 (2011). https://doi.org/10.1245/s10434-011-1582-x

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  • DOI: https://doi.org/10.1245/s10434-011-1582-x

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