Factors Influencing the Choice of Mastectomy Over Breast Conservation Surgery in Early Breast Cancer: A Prospective Qualitative Exploration of Patient Perspectives From India.

IF 1.9 3区 医学 Q3 ONCOLOGY
Rebba Ephraim, Madhabananda Kar, Mahesh Sultania, Suprava Naik, Saroj Majumdar, Dillip Kumar Muduly
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Abstract

Background: Breast conservation surgery (BCS) has not been a widely adopted treatment in early breast cancer despite its oncological outcomes similar to mastectomy. In emerging economies, BCS rates are < 40% compared to > 70% in the West. Hence, this study was undertaken to describe factors influencing the underutilization of BCS.

Methods: A prospective longitudinal study was conducted between September 2019 and December 2021 on patients with biopsy-proven early breast cancer eligible for BCS. The choice of surgery (mastectomy vs. breast conservation) by patients was recorded at initial diagnosis and staging. A predesigned structured questionnaire was used to identify the factors associated with their choice of mastectomy. The patients received multiple counseling sessions by the operating surgeon(s), and the choice of surgery was recorded again. Factors associated with the choice of surgery were identified and evaluated by univariate or multivariate logistic regression.

Results: Out of 238 consecutive patients operated on in the study period, 84 met eligibility criteria and were recruited. At the time of initial diagnosis and staging, 13 (15.5%) patients wanted BCS. After multiple counseling sessions, finally, 75 (89.3%) opted for BCS; however, 9 (10.7%) still wanted mastectomy. The factors influencing the choice of mastectomy were fear of outcome (90% of patients), followed by family influence (35%), radiation-related factors (30%), personal factors (25%), and surgery-related factors (25%).

Conclusions: Systematic counseling by the treating team markedly improved breast conservation acceptance rates from 15.5% to 89.3%. Fear of outcome is the major factor influencing the choice of mastectomy over BCS in early breast cancer patients suitable for BCS.

影响早期乳腺癌选择乳房切除术或保乳手术的因素:对印度患者观点的前瞻性定性研究
背景:尽管保乳手术(BCS)的肿瘤预后与乳房切除术相似,但它尚未成为早期乳腺癌广泛采用的治疗方法。在新兴经济体中,西方的BCS比率为70%。因此,本研究旨在描述影响BCS未充分利用的因素。方法:在2019年9月至2021年12月期间,对活检证实的早期乳腺癌患者进行了一项前瞻性纵向研究。患者的手术选择(乳房切除或乳房保留)记录在初始诊断和分期。使用预先设计的结构化问卷来确定与她们选择乳房切除术相关的因素。患者接受手术医师多次咨询,并再次记录手术选择。通过单因素或多因素logistic回归确定和评估与手术选择相关的因素。结果:在研究期间连续接受手术的238例患者中,84例符合入选标准。在初始诊断和分期时,13例(15.5%)患者需要BCS。经过多次咨询,最终75人(89.3%)选择了BCS;但仍有9人(10.7%)选择乳房切除术。影响选择乳房切除术的因素是对结果的恐惧(90%的患者),其次是家庭影响(35%)、辐射相关因素(30%)、个人因素(25%)和手术相关因素(25%)。结论:治疗组的系统咨询使保乳成功率由15.5%提高到89.3%。对预后的恐惧是影响适合BCS的早期乳腺癌患者选择乳房切除术而非BCS的主要因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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