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Choosing Between Mastectomy and Breast-Conserving Therapy: Is Patient Distress an Influencing Factor?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast-conserving therapy (BCT) offers oncologic outcomes similar to those of mastectomy, yet many patients, when provided the option, choose mastectomy. This study aimed to evaluate the relationship between patient-reported distress and surgical decisions and to determine factors predictive of choosing BCT versus mastectomy.

Methods

Patients with newly diagnosed breast cancer deemed candidates for BCT who completed a distress screen at their initial visit to an academic institution between 2016 and 2019 were retrospectively reviewed. This screening tool captures distress in emotional, social, health, and practical domains on a scale of 0 to 10. The distress scores were compared against surgical decisions using nonparametric Wilcoxon rank-sum tests. Patient factors associated with surgical choice were analyzed using chi-square, Fisher’s exact, and Student’s t tests. A two-sided p value lower than 0.05 was considered significant.

Results

Of 506 patients deemed eligible for BCT, 430 (85%) chose BCT and 76 (15%) pursued mastectomy. The distress levels did not differ significantly between the surgical options. The patients who underwent mastectomy were on the average younger (50.7 vs 60.4 years; p < 0.0001), presented with palpable masses (p < 0.0001), had stage 0, 2, or 3 versus stage 1 disease (p < 0.0001), sought consultation for second opinions (19.7% vs 8.6%; p = 0.0032), received neoadjuvant chemotherapy (31.6% vs 16.3%; p = 0.0016), or had deleterious gene mutations (21.1% vs 5.1%; p < 0.0001).

Conclusions

Distress was not associated with the pursuit of surgical treatment. Rather, younger age, search for a second opinion, and a palpable mass present at presentation were associated with more aggressive surgical decisions. Understanding factors that influence surgical decision-making is critical in guiding informed decisions that reflect patient values.

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Acknowledgment

This work was supported by the Health Data Compass Data Warehouse Projects (healthdatacompass.org) and the Surgical Outcomes and Applied Research (SOAR) Program, which are a collaboration between the University of Colorado Department of Surgery and the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Victoria Huynh MD, Gretchen Ahrendt MD, Simon Kim MD, Justin Cohen MD MHS & Sarah E. Tevis MD

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Jerry Yang BS

  3. Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA

    Michael Bronsert PhD MS

  4. Georgetown University, Washington, DC, USA

    Abigail Ludwigson BS

  5. Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Daniel D. Matlock MD MPH

  6. Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA

    Karen Hampanda PhD MPH

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  1. Victoria Huynh MD
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Correspondence to Sarah E. Tevis MD.

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Huynh, V., Yang, J., Bronsert, M. et al. Choosing Between Mastectomy and Breast-Conserving Therapy: Is Patient Distress an Influencing Factor?. Ann Surg Oncol 28, 8679–8687 (2021). https://doi.org/10.1245/s10434-021-10323-4

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  • DOI: https://doi.org/10.1245/s10434-021-10323-4

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