V.Е. Karasev
KGMA — branch campus of the FSBEI FPE RMACPE MOH Russia, Kazan
Karasev V.E. — PhD (Medicine), Head of the Department of Surgery of tumors of the breast and soft tissues, Assistant Professor of the Department of Plastic Surgery
36 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-927-035-45-55, e—mail: ilnur-faritovich@mail.ru, ORCID ID: 0000-0002-6134-8719
Abstract. Breast cancer (BC) ranks first in the structure of cancer morbidity among women worldwide. Radical mastectomy, accompanied by a pronounced aesthetic defect, exerts a substantial psychotraumatic impact, which determines the relevance of investigating quality of life (QoL) in patients depending on the extent of surgical intervention.
The purpose — to assess the dynamics of QoL and psychoemotional status in BC patients undergoing various types of surgical treatment at the preoperative stage and during a 5-year postoperative follow-up.
Material and methods. A prospective study enrolled 577 patients with verified BC, allocated into three subgroups: A — radical mastectomy without reconstruction; B — mastectomy with immediate reconstruction; C — delayed reconstruction. The control group comprised 40 women scheduled for aesthetic mammoplasty. QoL was assessed using the SF-36 and BREAST-Q questionnaires, psychoemotional status — using the Hospital Anxiety and Depression Scale (HADS) before surgery, at 6 months, and at 5 years postoperatively. Non-parametric statistical methods were applied.
Results. At the preoperative stage, the SF-36 total score decreased by 19.7–25.9% relative to controls (p < 0.05) and clinically significant levels of anxiety and depression. At 5-year follow-up, patients in subgroups B and C demonstrated a significant increase in psychosocial well-being (PW) by 64.9 and 71.9%, satisfaction with breasts (SB) by 84.9 and 85.6%, and satisfaction with outcome (SO) by 62.7 and 54.2% (p < 0.001), respectively. In subgroup A, no significant dynamics were observed across most scales; the anxiety level exceeded the control value 10.7-fold (p < 0.0001).
Conclusion. Reconstructive surgery in BC patients provides a significant improvement in QoL and psychoemotional status regardless of the biological tumor subtype and disease stage, which justifies its integration into the combined treatment program.
Key words: breast cancer, quality of life, reconstructive surgery, mastectomy