1. Impact of Mastectomy on the Physical and Psychological Well-being of Breast Cancer Female Patients in the Gaza-Strip
Presented by:
MohamedRaed S. Elshami
Today we are going to talk about the Impact of Mastectomy on the Physical and Psychological Well-being of Breast Cancer Female Patients in the Gaza-Strip and you may wonder why I put this photo on the first slide. Well, I just want to emphasize a concept which is “the meaning of life is not just about money” even if we have poor economic circumstances like nowadays. For example, If you get insomnic, won’t you pay hundreds or even thousands of dollars to sleep? You can keep the answer!

2. Authors MohamedRaed S. Elshami Enas F. Alaloul Alaa A. Alhelu
Heba S. Baraka
Esraa S. Khader
Huda N. Abu Nemer
Israa M. Awad
This study would not have come light without the great efforts of:

3. Supervisors
Dr. Bettina Bottcher
Dr. Khamis Elessi

4. Outline Introduction Objective Methods Results Conclusions
Recommendations
Limitations
Acknowledgements

5. Introduction Previous studies Our study
Although there are many studies that have examined the medical and clinical consequences of breast cancer (BC) and mastectomy, this study is the first one to determine the impacts affecting the physical (PWB) and psychological wellbeing (PsWB) of BC female patients who underwent mastectomy in the Gaza-Strip (GS).

6. Objective To identify the various impacts of mastectomy on:
Physical well-being (PWP)
Psychological well-being (PsWB)
Among breast cancer (BC) survivors in the Gaza-Strip (GS).

7. Methods
Cross-sectional study
173 female patients

8. Study Location and Period
Al- Shifa Hospital, Gaza.
Al-Rantisi Hospital, Gaza.
European Gaza Hospital, Khanyounis.
From August 2015 to April 2016.

9. Inclusion Criteria: Female Age= 25 to 75 years. Married
Oriented and coherent.
Able to give a consent.

10. Inclusion Criteria (Ctd)
Mastectomy before at least 6 months at:
Al- Shifa Hospital, Gaza.
European Gaza Hospital, Khanyounis.
In addition, patients should have mastectomy before at least 6 months prior to filling the questionnaire either at …. Or ……

11. Questionnaire Self-designed questionnaire filled during an interview
5-point Likert scale
Reviewed by 15 experts in the field
Our questionnaire was a self-designed questionnaire filled during an interview. We used a 5-point likert scale to measure the variables and this questionnaire was reviewed by 15 experts in the field.

12. Questionnaire 3 sections: Socio-demographic data PWB PsWB
It included 3 sections:

13. Data Analysis
SPSS software.

14. Results
When we looked at the age groups of our patients, we had 3 mains groups. The age of 32.9% of patients was 46 years of less. 34.7% had an age from 47 to 56 and 32.4% were 57 years or more

15. Body Mass Index (BMI)
When we calculated the body mass index, we found that only 14.5% had a normal BMI while 32.9% were overweight and 52.6% were obese.

16. Treatment
Having looked at the treatment the patients received, we found that:
Only 3.5% had surgery only 2.3% had surgery & radiotherapy 38.2% had surgery and received chemotherapy
The majority 56.1% had a combination of surgery and radiochemotherapy

17. Type of Surgery
With regard to type of surgery, only 16.8% had breast conserving surgeries while the rest had MRM

18. When was the surgery?
Before filling the data collection sheet, the surgery was done before 6 months to 1 year in 43.4%, before 1 yr to 4 yr in 25.4% and before more than 4 yr in 31.2%.

19. Impact on PWB
When we asked our patients about the impact of mastectomy on their PWB, we had 3 main answers. Fatigue was reported in the first position with 57.3% followed by menopausal symptoms in 48.6% and loss of appetite in 42.2%

20. Impact on PWB (Ctd)
In addition, 26.6% were suffering from menstrual disturbances, 20.8% from sleep disturbances, weight gain was reported in 18.5% and weight loss in 15.6%.

21. Impact on PsWB
We also asked our patients about their PsWB after 5 stations through their treatment journey. We found that, patients were impacted the most after chemotherapy with 75.8%. And it was surprising to find that the negative psychological impact was more significant after diagnosis of BC rather than after mastectomy itself! Among those who received radiotherapy, 19.7% reported an impact on their PsWB while among those who had hormonal therapy 15.6% did.

22. Conclusions (1)
The overall PWB among BC patients after mastectomy was decreased with many different complaints.

23. Conclusions (2)
The impact of BC on women’s PsWB is stronger after the diagnosis of BC than after mastectomy. This is probably due to their natural adaptation.

24. Conclusions (3)
The rate of breast conserving surgeries is extremely low.

25. Recommendations (1)
To hold workshops for families of mastectomized patients to show the significance of family support to their PsWB.

26. Recommendations (2)
To establish a visiting program to psychiatric clinics at Gaza Community Mental Health Programme for these patients.

27. Recommendations (3)
Further research to look for causes of the low rate of breast-conserving surgeries.
And by the way, the IUG Medical School is conducting a research to study that. Of course everyone is welcome to participate.

28. Limitations
The crowded oncology clinics
Securing privacy.

29. Acknowledgments Dr. Sobhi Skaik Dr. Yehia Abed Dr. Bassam Abu Hamad
Dr. Essam Awadallah
Dr. Alaa Abu Sabah
Dr. Khaled Thabet
Dr. Ahmed Alshorafa
Dr. Tayseer Diab
Dr. Ayesh Sammour
Dr. Yousif Aljeesh
Dr. Sanaa Abu Dagga
Dr. Anwar Alabadsa
Dr. Atef Alagha
Dr. Mahmoud Abu Daff
Dr. Samir Qouta