Patients awaiting mastectomy report increased depression, anxiety, and decreased quality of life compared with patients awaiting lumpectomy for treatment of breast cancer

• Published in: Canadian Journal of Surgery Vol. 65; p. S102
• Main Author: Tang, Katelynn
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01.11.2022
• Subjects: Anxiety; Breast cancer; Lumpectomy; Mastectomy; Mental depression; Mental disorders; Mental health
• ISSN: 0008-428X; 1488-2310

Background: There is a trend to increasing mastectomy for treatment of breast cancer despite studies demonstrating equivalent survival and better postoperative outcomes with lumpectomy. There is a need to better understand the constellation of physical and mental health conditions patients face in the preoperative period. Methods: This study's objective was to measure aspects of patients' preoperative mental health and identify differences between patients scheduled for mastectomy and lumpectomy. This study was based on a prospectively recruited cohort of consecutive patients scheduled for breast cancer surgery at our institution between April 2016 and July 2020. Preoperatively, participants completed a survey that included the Patient Health Questionnaire-9 (PHQ-9) for depression, the General Anxiety Disorder-7 (GAD-7) for anxiety, the pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G), known as the PEG, for pain and the EQ-5D(5L) for health status. Participants also reported their chronic health conditions. Scores were calculated for each instrument and compared for mastectomy and lumpectomy. Results: The overall response rate was 31%, with 667 participants. Average age was 59 years. The most common comorbidities were hypertension (27%), arthritis (24%) and depression (13%.) Among participants, 477 were scheduled for lumpectomy (71.5%) and 190 were scheduled for mastectomy (28.5%). Mastectomy patients reported more severe symptoms of anxiodepressive disorders with higher levels of depression (5.3 v. 4.2, p < 0.01) and anxiety (5.7 v. 3.9, p < 0.01). There were no differences in pain. Participants scheduled for lumpectomy reported high health status compared with participants scheduled for mastectomy (75.0 v. 70.7, p < 0.01). Patients scheduled for mastectomy reported more severe symptoms of depression and anxiety than those scheduled for lumpectomy. Conclusion: This information will be useful when counselling patients about surgical options. Preoperative referral to mental health providers may offer an opportunity to enhance perioperative care.