Association Between Breast Reconstruction Surgery and Quality of Life in Iranian Breast Cancer Patients
Breast reconstruction (BR) surgery is not common for the treatment of breast cancer in low- and middle-income countries, including Iran. We evaluated the quality of life (QoL) in Iranian breast cancer patients who underwent BR at the Cancer Institute of Iran. We compared patients who had BR with breast cancer patients who had a radical mastectomy as the control group, matched for age, and time since surgery. We interviewed the cases and controls and collected data about QoL using EORTC-Q30 and EORTC-Q23 questionnaires. We also obtained personal and clinical data for the patients and controls. We compared 61 BR and 45 radical mastectomy patients. The BR patients had a higher level of education (73.8%) than the mastectomy patients (27.3%). In addition, the BR patients had a higher employment rate (58%) than the mastectomy patients (4.4%). QoL was significantly better among BR patients compared to the control group (P<0.05). In the multivariable analyses, the BR patients had significantly lower scores of pain, fatigue, and diarrhoea than the controls. Breast cancer patients who underwent BR surgery had a higher quality of life scores in some domains compared to the radical mastectomy. Socioeconomic factors and awareness of the patients about BR was crucial for choosing BR among Iranian patients.
Asadzadeh Vostakolaei F, Broeders MJ, Mousavi SM, Kiemeney LA, Verbeek AL. The effect of demographic and lifestyle changes on the burden of breast cancer in Iranian women: A projection to 2030. Breast 2013;22:277-81.
Harirchi I1, Karbakhsh M, Montazeri A, Ebrahimi M, Jarvandi S, Zamani N, et al. Decreasing trend of tumor size and downstaging in breast cancer in Iran: results of a 15-year study. Eur J Cancer Prev 2010;19:126-30.
Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, Montazeri A, et al. Twenty years of breast cancer in Iran: downstaging without a formal screening program. Ann Oncol 2011;22:93-7.
Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: History and an update on current technique. J Plast Reconstr Aesthet Surg 2006;59:571-9.
Sánchez-Guerrero J, Colditz GA, Karlson EW, Hunter DJ, Speizer FE, Liang MH. Silicone breast implants and the risk of connective-tissue diseases and symptoms. N Engl J Med 1995;332:1666-70.
Brohim RM, Foresman PA, Hildebrandt PK, Rodeheaver GT. Early tissue reaction to textured breast implant surfaces. Annals of plastic surgery 1992;28:354-62.
Wilkins EG, Alderman AK. Breast reconstruction practices in North America: Current trends and future priorities. Semin Plast Surg 2004;18:149-55.
Agarwal G, Ramakant P, Sánchez Forgach ER, Rendón JC, Chaparro JM, Basurto CD, et al. Breast cancer care in developing countries. World J Surgery 2009;33:2069-76.
Elder EE, Brandberg Y, Björklund T, Rylander R, Lagergren J, Jurell G, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: A prospective study. Breast 2005;14:201-8.
Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, et al. Guideline implementation for breast
healthcare in low‐income and middle‐income countries . 43-2221:113:2008Cancer.
Preminger BA, Pusic AL, McCarthy CM, Verma N, Worku A, Cordeiro PG. How should quality-of-life data be incorporated into a cost analysis of breast reconstruction? A consideration of implant versus free TRAM flap procedures." Plastic and reconstructive surgery 2008;121:1075-82.
Montazeri A, Harirchi I, Vahdani M, Khaleghi F, Jarvandi S, Ebrahimi M. The EORTC breast cancer- specific quality of life questionnaire (EORTC QLQ- BR23): translation and validation study of the Iranian version. Qual Life Res 2000;9:177-84.
Montazeri A1, Harirchi I, Vahdani M, Khaleghi F, Jarvandi S, Ebrahimi M, et al. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version. Support Care Cancer 1999;7:400-6.
Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg
Han J, Grothuesmann D, Neises M, Hille U, Hillemanns P. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet 2010;282:75-82.
Andrade WN, Semple JL. Patient self-assessment of the cosmetic results of breast reconstruction. Plastic Reconstr Surg 2006;117:44-7.
Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study. Plastic and reconstructive surgery 2003;111:1060-8.
Arora NK, Gustafson DH, Hawkins RP, McTavish F, Cella DF, Pingree S. Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma. Cancer 2001;92:1288-98.
Nissen MJ, Swenson KK, Ritz LJ, Farrell JB, Sladek ML, Lally RM. Quality of life after breast carcinoma surgery. Cancer 2001;91:1238-46.
Youssef A, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz ER, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surgical Oncol 2007;14:3078-89.
Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 2000;92:1422-9.
Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem B, Morrow M, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Quality of Life Research 2005;14:1467-79.
Wehrens K, Cuypers W, Boeckx W, van der Hulst R.
Psychological profile of women seeking breast reconstruction and quality of life assessment after surgery. Eur J Plast Surg 2005;28:264-7.
Nahabedian M. Overview of breast Reconstruction.Online. (Accessed March 2016, 12, at http://www.uptodate.com/contents/overview-of-breast-rec onstruction).
Omranipour R, Lebaschi AH, Mohagheghi MA, Arab- Kheradmand A, Abasahl A. Outcomes of breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flap at cancer institute, a retrospective study of 10 years of experience. Acta Med Iran 2008;46:218-24.
Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009;124:345-53