Breast Cancer Treatments and their Impact on Quality of Life Kim Arias

The Facts 212,000 new cases this year 41,000 will die this year Rising 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 Sex Age Genetics Family Hx Personal Hx Early onset of menses Abnormal 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: Pain Metastasis Death Feminity Body image Relationships

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 important Help maintain social support – support groups, therapy