Changes in the degree of satisfaction and quality of life in breast cancer patients who are candidates for breast conservation but opted for mastectomy: A single-center prospective study.

Abstract

584 Background: Randomized trials have shown that breast-conserving surgery (BCS) and total mastectomy (TM) provide comparable survival outcomes for early breast cancer patients. Consequently, the choice of surgery is now considered a preference-based shared decision-making process. While studies have examined quality of life (QoL) in TM and BCS patients, it remains unclear how choosing TM over BCS affects postoperative QoL and satisfaction. This single-center prospective trial investigated the longitudinal impact of TM on QoL and satisfaction in the BCS-eligible patients who voluntarily opted for TM. Methods: We prospectively screened newly diagnosed breast cancer patients who are eligible for BCS based on the preoperative clinical assessment between Nov 2021 and June 2024 at Seoul National University Hospital. Patients were allowed to choose between TM and BCS through the shared decision-making process, and were enrolled according to the selected surgical method. A series of surveys were conducted using the BREAST-Q questionnaire and Decision Regret Scale (DRS) before and between 6-24months following surgery and then compared the results between two groups. Results: A total of 68 patients were enrolled; 28 opted for TM, and 40 underwent BCS, with two patients lost to follow-up in the TM group. The TM group was significantly older than the BCS group (57.92 vs. 51.43 years, p=0.015), and had larger preoperative tumor sizes (25.77mm vs. 17.88mm, p=0.001). Postoperatively, satisfaction with the breast (62.0 vs. 53.3, p=0.013) and physical well-being (chest) (83.9 vs. 77.5, p=0.004) decreased significantly. Satisfaction with the breast was significantly lower in the TM group compared to BCS (62.7 vs. 38.7, p<0.001). Psychosocial well-being (80.3 vs. 58.1, p<0.001), sexual well-being (55.3 vs. 24.2, p<0.001), and physical well-being (80.9 vs. 72.9, p=0.043) were all lower in the TM group. When comparing pre- and postoperative scores, the TM group experienced greater declines in breast satisfaction (-1.38 vs. -21.34, p=0.007), psychosocial well-being (5.71 vs. -8.40, p=0.004), and sexual well-being (1.55 vs. -17.83, p=0.004). The TM group also had significantly higher DRS scores (21.92 vs. 13.52, p=0.036), indicating greater regret. Conclusions: Our data demonstrates that patients who opted for TM over BCS for their breast cancer surgery may experience more profound decline in QoL and higher degree of regret after their surgery. These findings should be incorporated into the shared decision-making process when choosing optimal surgical treatment in early breast cancer patients who are eligible for BCS.