Breast Cancer Treatments and their Impact on Quality of Life

1. Breast Cancer Treatments and their Impact on Quality of Life Kim Arias

2. The Facts • 212,000 new cases this year • 41,000 will die this year • Rising incidence since 1980

3. Risk Factors - Modifiable • Having children ↓ • Breast feeding ↓ • Use of OCs ↑ • Long-term hormone therapy ↑ • High Alcohol consumption ↑ • Obesity/High-fat diet ↑ • Use of diethylstilbestrol ↑ • Previous chest radiation ↑ • Smoking ↑

4. Risk Factors – Non-modifiable • Sex • Age • Genetics • Family Hx • Personal Hx • Early onset of menses • Abnormal Bx

5. Screening and Detection • Breast Self Exam • Clinical Breast Exam • Mammography – GOLD STANDARD • Genetic Testing • Up and coming – laser and MRI

6. Psychological Distress • Stems from worries about: • Pain • Metastasis • Death • Feminity • Body image • Relationships

7. The Problem • Healthcare providers are very good at and well-equipped to prepare patients for the acute distress they will experience during treatment. • We are not so good at preparing women for the distress and sequelae they will experience AFTER initial treatments.

8. Breast Cancer Treatments • Four Main Tx • Breast-conserving surgeries • Lumpectomy • Partial mastectomy • Total mastectomy • Simplified – entire breast and some lymph nodes • Modified radical – whole breast, most lymph nodes, lining of chest muscles, some muscle • Radical – breast, all chest muscles underneath and all lymph nodes • Radiation Therapy • Chemotherapy

9. Treatments

10. What I found…Prophylactic Tx • Bilateral Prophylactic Mastectomy • Lowers risk by 90% • No effect on sex life • Older women more satisfied with outcome • 88% “missed” breasts • 94% lost sensitivity • Small portion did not want to touch or be touched • Body image – studies are inconclusive • Contralateral Prophylactic Mastectomy • Decreases mortality • 87% satisfied with outcome • 50% still worried about recurrence vs. 74% • Contentment = to those who do not have CPM

11. Surgical Tx • Breast-Conserving Therapy • 42% rated post-op body appearance excellent • 41% rated good • 71% reported no change in sex life • 29% decreased sex life, 25% more inhibited • More worried about recurrence • Mastectomy • Long-term quality of life = BCT pts • Body image not rated equal, BCT favored

12. Adjuvant Tx • Chemotherapy • Psychological symptoms • Fatigue • Long-term difficulty concentrating • Long-term sexual disfunction • Radiation • Lethargy • Fatigue • Not as pronounced in BCT as mastectomy pts • 7 wks – 3 months after d/c Tx

13. Reconstruction • None • No detectable difference in quality of life • Negative body image – favors reconstruction • Quality of life for reconstruction and BCT pts rated comparable • 88% satisfied, 77% highly satisfied • Delayed • Less distress, anxiety, depression and increased quality of life than in immediate • Immediate • High prevalence of psychosocial impairment and functional disability pre-op • Those highly satisfied had very high levels of pre-op education

14. The Conclusion • BCT and Reconstruction favor positive body image • Pre-operative body image and psychosocial health is a very high indicator of post-operative body image and psychosocial health • Treatment type doesn’t matter! Well, it kinda does... • Highest rated quality of life outcomes achieved with well-informed patients

15. OURJob • Educate Patients – treatments, side effects, outcomes • Let them choose – it’s their life! • Follow-up = SUPER important • Help maintain social support – support groups, therapy