Does CPM Reduce Breast Cancer Survivors' Anxiety?

Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer

Parker PA, Peterson SK, Shen Y, et al
J Clin Oncol. 2018;36:2630-2638

Study Summary

The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. The authors of the current paper describe a prospective study that examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM.

Participants included women receiving care at MD Anderson Cancer Center and at a community-based clinic in Houston, Texas, between March 2014 and December 2015. Women with unilateral, nonhereditary invasive breast cancer (stages I-III) completed questionnaires before and 1, 6, 12, and 18 months after surgery. The primary psychosocial measures were cancer worry and cancer-specific distress; secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret.

Among a total of 288 women (mean age, 56 years; 58% non-Hispanic white) included in the analysis, 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress, cancer worry, and body image concerns than women who did not have CPM. In a multivariable repeated-measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress and poorer QOL. There was a significant interaction between the survey time points and cancer worry in the CPM group, suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM.

QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than in patients who did not have CPM after surgery.

This study provides important information to assist clinical oncologists and surgeons in advising patients regarding surgical choices after a diagnosis of invasive breast cancer. The authors concluded that fear and worry may be foremost concerns at the time that surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.

Viewpoint

The authors of this study have made an important contribution by studying—in a prospective manner—a cohort of women who chose to have CPM. The patient sample was recruited from an academic center in Houston and a community practice. The investigators studied physical and emotional well-being at predefined time points prior to and after surgery.

We know that many women with breast cancer worry, perhaps excessively and to the point of anxiety, about their future. We also know that surgery is not a good treatment for worry and concern. And yet this study shows that women who worry are more likely to opt for extensive surgery, including CPM. While this worry seems to be assuaged by undergoing these procedures, the same women report more distress in physical, emotional, social, and functional well-being, resulting in worse experiences of QOL.

Women diagnosed with breast cancer, especially younger women with family histories of cancer, are at risk for distress. This needs to be recognized and treated as long as symptoms persist.

Abstract

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Lidia Schapira. Does Contralateral Prophylactic Mastectomy Reduce Breast Cancer Survivors' Anxiety? - Medscape - Sep 28, 2018.

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