Survey Asks Women Whom They Trust Most When Selecting Breast Cancer Surgery and Reviews Postsurgical Satisfaction
A research team led by Rebecca M. Kwait, MD, Breast Health Fellow at The Breast Health Center at Women & Infants Hospital of Rhode Island, recently presented research indicating that when faced with a decision on the type of surgery to have for breast cancer, more women trust their own judgment over the input of their surgeon and even their partner. The findings were presented at the 2016 New England Association of Gynecologic Oncologists Annual Meeting.
“With the great advances in screening and treatment for breast cancer leading to prolonged survival rates as high as 98%, survivorship outcomes have become an increasingly important consideration among patients. Women must consider quality of life and intimacy after surgery; these become influencing factors when they make decisions about their care,” Dr. Kwait explained.
The proportion of early-stage breast cancer patients choosing mastectomy with reconstruction surgery over lumpectomy has been steadily increasing, prompting the team to wonder what factors are driving the decisions. In addition, while there is substantial research available showing the relationship between surgery and a woman's self-confidence and sexual pleasure, there was nothing identifying who or what influences her surgery-related decisions.
‘We know that women feel especially vulnerable when they receive a breast cancer diagnosis and turn to their support system, including their partner,” Dr. Kwait said. “We also know that greater support from a woman's partner leads to greater relationship satisfaction and less sexual difficulty in the long run.”
“However, the partner's role in treatment decision-making remained nuanced. No studies to date, that we were aware of, had evaluated the influence of a partner in surgical decision-making.”
Study Findings
Close to 400 women returned surveys as part of the study. Of those, 67.9% had lumpectomy, 8.6% had a mastectomy, and 23.5% had a mastectomy with breast reconstruction. More than 77% of participants were in a relationship, and almost 75% of those women reported that their partner attended their surgical consultation.
To the researchers' surprise, the majority of women having a mastectomy identified themselves as the most important influence on their surgical decision (56.6% of those having mastectomy with reconstruction, 46.3% having a mastectomy, and 42.7% having a lumpectomy). Women who chose a lumpectomy identified their surgeon as the most influential (44.2% having lumpectomy vs 39% having a mastectomy and 23.2% having a mastectomy with reconstruction).
“Only 7.5% of patients identified their partner as the greatest influence on their surgical choice,” Dr. Kwait noted. “Yet, within this subgroup, patients who chose a mastectomy with reconstruction valued their partner's opinion more than those who chose a mastectomy alone or a lumpectomy.”
Postsurgical Satisfaction
The researchers also asked about the patients' satisfaction with their breast appearance and the breast's role in intimacy both before and after cancer surgery. All levels of satisfaction dropped dramatically after surgery, with a significantly greater decrease in breast intimacy for women having a mastectomy with reconstruction.
“Nearly half of the patients—or 48.6%—who chose a mastectomy with reconstruction devalued the breast in intimacy postoperatively,” Dr. Kwait said. “Comparatively, only 20.4% of patients who chose lumpectomy experienced this change.”
This correlates with their finding that despite most patients making their own surgical choices, the type of surgery they have significantly impacts their romantic relationships. The majority of women surveyed reported that after surgery they were less comfortable undressed in front of their partner and experiencing less pleasure from caresses during intimacy. This was particularly true for patients who were eligible for a lumpectomy but instead opted for a mastectomy with reconstruction.
“Our findings highlighted a need for clinicians to mention specific things as part of the informed surgical consent discussions they have with their patients,” Dr. Kwait concluded.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
