The impact of psychiatric diagnoses on patient-reported satisfaction and quality of life in postmastectomy breast reconstruction Journal Article

   


Authors: Shamsunder, M. G.; Chu, J. J.; Polanco, T. O.; Yin, S.; Muniz, R. C.; James, M. C.; Mehrara, B. J.; Pusic, A. L.; Voineskos, S.; Nelson, J. A.
Article Title: The impact of psychiatric diagnoses on patient-reported satisfaction and quality of life in postmastectomy breast reconstruction
Abstract: Objective:The purpose of this study was to determine the prevalence of psychiatric diagnoses among a sample of breast reconstruction patients and measure the association between these diagnoses and reconstruction-related, patient-reported outcomes. Background:The impact of psychiatric disorders in conjunction with breast cancer diagnosis, treatment, and reconstruction have the potential to cause significant patient distress but remains not well understood. Methods:A retrospective review of postmastectomy breast reconstruction patients from 2007 to 2018 at Memorial Sloan Kettering Cancer Center was conducted. Patient demographics, comorbidities, cancer characteristics, psychiatric diagnoses, and BREAST-Q Reconstruction Module scores (measuring satisfaction with breast, well-being of the chest, psychosocial, and sexual well-being) at postoperative years 1 to 3 were examined. Mixed-effects models and cross-sectional linear regressions were conducted to measure the effect of psychiatric diagnostic class type and number on scores. Results:Of 7414 total patients, 50.1% had at least 1 psychiatric diagnosis. Patients with any psychiatric diagnoses before reconstruction had significantly lower BREAST-Q scores for all domains at all time points. Anxiety (50%) and depression (27.6%) disorders were the most prevalent and had the greatest impact on BREAST-Q scores. Patients with a greater number of psychiatric diagnostic classes had significantly worse patient-reported outcomes compared with patients with no psychiatric diagnosis. Psychosocial (beta: -7.29; 95% confidence interval: -8.67, -5.91), and sexual well-being (beta: -7.99; 95% confidence interval: -9.57, -6.40) were most sensitive to the impact of psychiatric diagnoses. Conclusions:Mental health status is associated with psychosocial and sexual well-being after breast reconstruction surgery as measured with the BREAST-Q. Future research will need to determine what interventions (eg, screening, early referral) can help improve outcomes for breast cancer patients with psychiatric disorders undergoing breast reconstruction.
Keywords: breast reconstruction; satisfaction; patient-reported outcomes; mental health; psychological distress; follow-up; women; early-stage; randomized-trial; cancer survivors; quality; body-image; psychiatric; depressive symptoms; menopausal symptoms; of life; breast-q; fertility concerns
Journal Title: Annals of Surgery
Volume: 277
Issue: 6
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2023-06-01
Start Page: e1313
End Page: e1323
Language: English
ACCESSION: WOS:000992555200041
DOI: 10.1097/sla.0000000000005478
PROVIDER: wos
PMCID: PMC9816355
PUBMED: 35793069
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Jonas A. Nelson -- Source: Wos
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MSK Authors
  1. Babak Mehrara
    449 Mehrara
  2. Rosario Costas Muniz
    103 Costas Muniz
  3. Jonas Allan Nelson
    210 Nelson
  4. Monique C James
    7 James
  5. Thais O Polanco
    24 Polanco
  6. Meghana G Shamsunder
    43 Shamsunder
  7. Jacqueline J. Chu
    27 Chu
  8. Shen Yin
    11 Yin
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