Quality of Life and Sexual Functioning of Women after Breast Cancer Surgery
Keywords:Breast cancer, Breast-conserving surgery, Mastectomy, Sexual functioning, Quality of life, Women, EORTC QLQ-BR23
BACKGROUND: Women with breast cancer can experience changes in sexual functioning and body images that can seriously affect their quality of life.
AIM: The aim of this research was to study the quality of life and sexual functioning of women after a mastectomy and after a breast-conserving surgery and to compare post-operative quality of life.
SUBJECTS AND METHODS: This cross-sectional study included 204 participants, 101 patients after a mastectomy and 103 patients after a quadrantectomy. The research was conducted using the Croatian version of the questionnaire of the European Organization for Research and Treatment of Breast Cancer, the questionnaire with the breast cancer module EORTC QLQ - BR 23.
RESULTS: On the EORTC QLQ –BR23 scale, participants with mastectomy rated their sexual functioning (p < 0.001), sexual pleasure (p < 0.001), and systemic side effects (p = 0.04) lower comparing to women after breast-conserving surgery. The overall functionality scale was significantly lower (p = 0.03) for women who underwent mastectomy compared to those who underwent breast-conserving surgery. Participants under 51 years of age had worse body image 1 month after mastectomy (p = 0.006), while sexual functioning was better (p = 0.03) than in older age groups. In breast-conserving surgery group, 1 month after surgery, participants in the age group of 61 years and older assessed body image better (p = 0.04) than in the younger age group. Sexual functioning was rated better by women aged 51–60 years (p = 0.03).CONCLUSION: Results of this study show that women after breast conserving surgery have better quality of life, better sexual functioning and less side effects of systemic therapy compared to women after mastectomy. The type of surgery, patient’s age and time passed after completion of treatment are important factors which influence sexual functioning and quality of life in breast cancer survivors.
Plum Analytics Artifact Widget Block
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. https://doi.org/10.3322/caac.20107 PMid:21296855
Croatian Institute of Public Health. Croatian National Cancer Registry. Cancer Incidence in Croatia 2015; 2018. Available from: https://www.hzjz.hr/wp-content/uploads/2018/03/Bilten_2015_rak_final.pdf. [Last accessed on 2020 Jun 18].
Yang Y, Liu L, Wang Y, Wu H, Yang X, Wang J, et al. The prevalence of depression and anxiety among Chinese adults with cancer: A systematic review and meta-analysis. BMC Cancer. 2013;13:393. https://doi.org/10.1186/1471-2407-13-393
Cheung KL. Treatment strategies and survival outcomes in breast cancer. Cancers (Basel). 2020;12(3):735. https://doi.org/10.3390/cancers12030735 PMid:32244985
Groenvold M. Health-related quality of life in early breast cancer. Dan Med Bull. 2010;57(9):B4184. PMid:20816024
Teo I, Reece GP, Christie IC, Guindani M, Marky MK, Heinberg LJ, et al. Body image and quality of life of breast cancer patients: Influence of timing and stage of breast reconstruction. Psychooncology. 2016;25(9):1106-12. https://doi.org/10.1002/pon.3952 PMid:26360810
Archangelo SC, Sabino Neto M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo). 2019;74:e883. https://doi.org/10.6061/clinics/2019/e883 PMid:31166474
Montazeri A. Health-related quality of life in breast cancer patients: A bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008;27(1):32. https://doi.org/10.1186/1756-9966-27-32 PMid:18759983
The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551-8. https://doi.org/10.1017/s0033291798006667 PMid:9626712
Fang S, Shu B, Chang Y. The effect of breast reconstruction surgery on body image among women after mastectomy: A meta-analysis. Breast Cancer Res Treat. 2013;137(1):13-21. https://doi.org/10.1007/s10549-012-2349-1 PMid:23225142
Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks, PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579-94. https://doi.org/10.1002/pon.991 PMid:16287197
Baucom DH, Porter LS, Kirby JS, Gremore TM, Keefe FJ. Psychosocial issues confronting young women with breast cancer. Breast Disease. 2006;23:103-13. https://doi.org/10.3233/bd-2006-23114
Henson HK. Breast cancer and sexuality. Sex Disabil. 2002;20(4):261-75. https://doi.org/10.1023/A:1021657413409
Howes BH, Watson DI, Xu C, Fosh B, Canepa M, Dean NR. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study. J Plast Reconstr Aesthet Surg. 2016;69(9):1184-91. https://doi.org/10.1016/j.bjps.2016.06.004 PMid:27406255
Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: A review. Maturitas. 2010;66(4):397-407. https://doi.org/10.1016/j.maturitas.2011.07.022 PMid:20439140
Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The EORTC breast cancer-specific quality-oflife questionnaire module: First results from a three-country field study. J Clin Oncol. 1996;14(10):2756-68. https://doi.org/10.1200/jco.1918.104.22.16856 PMid:8874337
Clinical Trial Database. EORTC. Available from: Available from: https://www.eortc.org/research_field/clinical-detail/15931. [Last accessed on 2020 Jun 18].
Pačarić S, Kristek J, Mirat J, Kondža G, Turk T, Farčić N, et al. The quality of life of Croatian women after mastectomy: A cross-sectional single-center study. BMC Public Health. 2018;18(1):1-8. https://doi.org/10.1186/s12889-018-5929-0 PMid:30097040
Dujmović A, Marčinko D, Bulić K, Kisić H, Duduković M, Mijatović D. Quality of Life and depression among female patients undergoing surgical treatment for breast cancer: A prospective study. Psychiatr Danub. 2017;29(3):345-50. https://doi.org/10.24869/psyd.2017.345
Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, On Behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual. Brussels: European Organisation for Reasearch and Treatmenr of Cancer; 2001.
Kostić S, Murtezani Z, Andrić Z, Ivanović N, Kozomara‖ Z, Kostić M, et al. Assessment of age-related influences on the quality of life of breast cancer patients before and after surgical treatment. Vojnosanitetski Pregled. 2020;2020:155. https://doi.org/10.2298/vsp180629155k
Liu Y, Xin T, Huang DY, Shen WX, Li L, Lv YJ, et al. Prognosis in very young women with triple-negative breast cancer: Retrospective study of 216 cases. Med Oncol. 2014;31:222. https://doi.org/10.1007/s12032-014-0222-2
Bantema-Joppe E, de Bock G, Woltman-van Iersel M, Busz DM, Ranchor AV, Langendijk JA, et al. The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy. Br J Cancer. 2015;112(4):636-43. https://doi.org/10.1038/bjc.2014.632 PMid:25602967
Ng ET, Ang RZ, Tran BX, Ho CS, Zhang Z, Tan W, et al. Comparing quality of life in breast cancer patients who underwent mastectomy versus breast-conserving surgery: A meta-analysis. Int J Environ Res Public Health. 2019;16(24):4970. https://doi.org/10.3390/ijerph16244970 PMid:31817811
Murgić J, Soldić Ž, Vrljić D, Samija I, Kirac I, Bolanca A. Quality of life of Croatian breast cancer patients receiving adjuvant treatment--comparison to long-term breast cancer survivors. Coll Antropol. 2012;36(4):1335-41. PMid:23390830
Sharma N, Purkayastha A. Factors affecting quality of life in breast cancer patients: A descriptive and cross-sectional study with review of literature. J Midlife Health. 2017;8(2):75-83. https://doi.org/10.4103/jmh.jmh_15_17 PMid:28706408
Kim J, Han JY, Shaw B, McTavish F, Gustafson D. The roles of social support and coping strategies in predicting breast cancer patients’ emotional well-being: Testing mediation and moderation models. J Health Psychol. 2010;15:543-52. https://doi.org/10.1177/1359105309355338 PMid:20460411
Kroenke CH, Quesenberry C, Kwan ML, Sweeney C, Castillo A, Caan BJ. Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the life after breast cancer epidemiology (LACE) study. Breast Cancer Res Treat. 2013;137(1):261-71. https://doi.org/10.1007/s10549-012-2253-8 PMid:23143212
Bakewell RT, Volker DL. Sexual dysfunction related to the treatment of young women with breast cancer. Clin J Oncol Nurs. 2005;9(6):697-702. https://doi.org/10.1188/05.cjon.697-702 PMid:16381545
Wang F, Chen F, Huo X, Xu R, Wu L, Wang J, et al. A neglected issue on sexual well-being following breast cancer diagnosis and treatment among Chinese women. PLoS One. 2013;8(9):e74473. https://doi.org/10.1371/journal.pone.0074473 PMid:24086349
Iskandar ME, Dayan E, Lucido D. Factors influencing incidence and type of postmastectomy breast reconstruction in an urban multidisciplinary cancer center. Plast Reconstr Surg. 2015;135(2):270e-6. https://doi.org/10.1097/prs.0000000000000888
Morrow M, Scott SK, Menck HR, Mustoe TA, Winchester DP. Factors influencing the use of breast reconstruction postmastectomy: A national cancer database study. J Am Coll Surg. 2001;192(1):1-8. https://doi.org/10.1016/s1072-7515(00)00747-x PMid:11192909
Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national cancer data base. J Am Coll Surg. 2012;215(5):658-66. https://doi.org/10.1016/j.jamcollsurg.2012.07.008 PMid:22921327
Shahhosseini Z, Gardeshi ZH, Pourasghar M, Salehi F. A review of affecting factors on sexual satisfaction in women. Mater Sociomed. 2014;26(6):378-81. https://doi.org/10.5455/msm.2014.26.378-381
Enien MA, Ibrahim N, Makar W, Darwish D, Gaber M. Healthrelated quality of life: Impact of surgery and treatment modality in breast cancer. J Can Res Ther. 2018;14(5):9557-63. https://doi.org/10.4103/0973-1482.183214 PMid:30197331
Choi EK, Kim IR, Chang O, Kang D, Nam SJ, Lee JE, et al. Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. Psychooncology. 2014;23(10):1103-10. https://doi.org/10.1002/pon.3531 PMid:24664939
Werbel T, Cohen PR. Persistent alopecia in a breast cancer patient following taxane chemotherapy and adjuvant endocrine therapy: Case report and review of post-treatment hair loss in oncology patients with breast cancer. Cureus. 2018;10(7):e3056. https://doi.org/10.7759/cureus.3056 PMid:30280054
Harcourt D, Frith H. Women’s experiences of an altered appearance during chemotherapy: An indication of cancer status. J Health Psychol. 2008;13(5):597-606. https://doi.org/10.1177/1359105308090932 PMid:18519434
Merchant TE, McCormick B, Yahalom J, Borgen P. The influence of older age on breast cancer treatment decisions and outcome. Int J Radiat Oncol Biol Phys. 1996;34(3):565-70. https://doi.org/10.1016/0360-3016(95)02167-1 PMid:8621279
Brunet J, Sabiston CM, Burke S. Surviving breast cancer: Women’s experiences with their changed bodies. Body Image. 2013;10(3):344-51. https://doi.org/10.1016/j.bodyim.2013.02.002 PMid:23490552
Jassim GA, Whitford DL. Quality of life of Bahraini women with breast cancer: A cross sectional study. BMC Cancer. 2013;13:212. https://doi.org/10.1186/1471-2407-13-212
Arora NK, Gustafson DH, Hawkins RP, McTavish F, Cella DF, Pingree S, et al. Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: A prospective study. Cancer. 2001;92:1288-98. https://doi.org/10.1002/1097-0142(20010901)92:5<1288:aidcncr1450>3.0.co;2-e PMid:11571745
Schover LR. Counseling cancer patients about changes in sexual function. Oncology (Williston Park). 1999;13(11):1585-91. PMid:10581604
Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D. Quality of life following breast-conserving therapy or mastectomy: Results of a 5-year prospective study. Breast J. 2004;10(3):223-31. https://doi.org/10.1111/j.1075-122x.2004.21323.x PMid:15125749
Cash TF, Smolak L. Body Image: A Handbook of Science, Practice, and Prevention. New York: Guilford Press; 2011.
Sherman KA, Woon S, French J, Elder E. Body image and psychological distress in nipple-sparing mastectomy: The roles of self-compassion and appearance investment. Psychooncology. 2017;26(3):337-45. https://doi.org/10.1002/pon.4138 PMid:27167009
Grogan S, Mechan J. Body image after mastectomy: A thematic analysis of younger women’s written accounts. J Health Psychol. 2017;22(11):1480-90. https://doi.org/10.1177/1359105316630137 PMid:26916388
Sun L, Ang E, Ang WH, Lopez V. Losing the breast: A metasynthesis of the impact in women breast cancer survivors. Psychooncology. 2018;27(2):376-85. https://doi.org/10.1002/pon.4460 PMid:28544436
Ahmed S, Iqbal N, Emara M, Le D. Effect of surgery and adjuvant therapy in reproductive and sexual dysfunction in premenopausal women with breast cancer. Reprod Syst Sex Disord. 2016;5(2):169. https://doi.org/10.4172/2161-038x.1000169
Paredes CG, de Pinho Pessoa SG, Teles DT, de Amorim DN, Araújo Silveira J, Barreto Araujo PR. The impact of breast reconstruction on the quality of life of patients after mastectomy at the plastic surgery service of Walter Cantídio university hospital. Rev Bras Cir Plást. 2013;28(1):100-4. https://doi.org/10.1590/s1983-51752013000100017
Butler PD, Nelson JA, Fischer JP. Racial and age disparities persist in immediate breast reconstruction: An updated analysis of 48,564 patients from the 2005 to 2011 American college of surgeons national surgery quality improvement program data sets. Am J Surg. 2016;212(1):96-101. https://doi.org/10.1016/j.amjsurg.2015.08.025 PMid:26545345
Ganz PA, Schag AC, Lee JJ, Polinsky ML, Tan SJ. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer. 1992;69(7):1729-38. https://doi.org/10.1002/1097-0142(19920401)69:7<1729:aidcncr2820690714>3.0.co;2-d PMid:1551058
Cobo-Cuenca AI, Martin-Espinosa NM, Sampietro-Crespo A, Rodriguez-Borrego MA, Carmona-Torres JM. Sexual dysfunction in Spanish women with breast cancer. PLoS One. 2018;13(8):e0203151. https://doi.org/10.1371/journal.pone.0203151 PMid:30169506
Avis NE, Crawford S, Manuel J. Psychosocial problems among young women with breast cancer. Psychooncology. 2004;13(5):295-308. https://doi.org/10.1002/pon.744 PMid:15133771
Ljungman L, Ahlgren J, Petersson LM, Flynn KE, Weinfurt K, Gorman JR, et al. Sexual dysfunction and reproductive concerns in young women with breast cancer: Type, prevalence, and predictors of problems. Psychooncology. 2018;27(12):2770-7. https://doi.org/10.1002/pon.4886 PMid:30203884
Boswell EN, Dizon DS. Breast cancer and sexual function. Transl Androl Urol. 2015;4(2):160-8. PMid:26816822
How to Cite
Copyright (c) 2020 Stana Pačarić, Želimir Orkić, Andrea Milostić-Srb, Tajana Turk, Nikolina Farčić, Štefica Mikšić, Silvia Adamčević, Ivan Erić, Zvjezdana Gvozdanović, Nika Srb (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.