Breast Cancer Treatments and their Impact on Quality of Life

Kim Arias

The Facts

212,000 new cases this year41,000 will die this yearRising incidence since 1980

Risk Factors - Modifiable

Having children ↓ Breast feeding ↓ Use of OCs ↑ Long-term hormone therapy ↑ High Alcohol consumption ↑ Obesity/High-fat diet ↑ Use of diethylstilbestrol ↑ Previous chest radiation ↑ Smoking ↑

Risk Factors – Non-modifiable

SexAgeGeneticsFamily HxPersonal HxEarly onset of mensesAbnormal Bx

Screening and Detection

Breast Self Exam Clinical Breast Exam Mammography –

GOLD STANDARD Genetic Testing Up and coming –

laser and MRI

Psychological Distress

Stems from worries about:PainMetastasisDeathFeminityBody imageRelationships

The Problem

Healthcare providers are very good at and well-equipped to prepare patients for the acute distress they will experience during treatment.

We are not so good at preparing women for the distress and sequelae they will experience AFTER initial treatments.

Breast Cancer Treatments

Four Main Tx Breast-conserving surgeries

Lumpectomy Partial mastectomy

Total mastectomy Simplified – entire breast and some lymph nodes Modified radical – whole breast, most lymph nodes, lining

of chest muscles, some muscle Radical – breast, all chest muscles underneath and all

lymph nodes Radiation Therapy Chemotherapy

Treatments

What I found…Prophylactic Tx

Bilateral Prophylactic Mastectomy Lowers risk by 90% No effect on sex life Older women more satisfied with outcome 88% “missed” breasts 94% lost sensitivity Small portion did not want to touch or be touched Body image – studies are inconclusive

Contralateral Prophylactic Mastectomy Decreases mortality 87% satisfied with outcome 50% still worried about recurrence vs. 74% Contentment = to those who do not have CPM

Surgical Tx

Breast-Conserving Therapy 42% rated post-op body appearance excellent 41% rated good 71% reported no change in sex life 29% decreased sex life, 25% more inhibited More worried about recurrence

Mastectomy Long-term quality of life = BCT pts Body image not rated equal, BCT favored

Adjuvant Tx

Chemotherapy Psychological symptoms Fatigue Long-term difficulty concentrating Long-term sexual disfunction

Radiation Lethargy Fatigue Not as pronounced in BCT as mastectomy pts 7 wks – 3 months after d/c Tx

Reconstruction

None No detectable difference in quality of life Negative body image – favors reconstruction Quality of life for reconstruction and BCT pts rated comparable 88% satisfied, 77% highly satisfied

Delayed Less distress, anxiety, depression and increased quality of life

than in immediate Immediate

High prevalence of psychosocial impairment and functional disability pre-op

Those highly satisfied had very high levels of pre-op education

The Conclusion

BCT and Reconstruction favor positive body image

Pre-operative body image and psychosocial health is a very high indicator of post-operative body image and psychosocial health

Treatment type doesn’t matter! Well, it kinda does...

Highest rated quality of life outcomes achieved with well-informed patients

OUR Job

Educate Patients – treatments, side effects, outcomes

Let them choose – it’s their life!Follow-up = SUPER importantHelp maintain social support – support

groups, therapy