The Impact Of A Psychiatric Diagnosis On Patient-reported Satisfaction And Quality Of Life In Post-mastectomy Breast Reconstruction
Meghana G. Shamsunder, MPH1, Thais O. Polanco, MD1, Robert J. Allen, MD1, Colleen M. McCarthy, MD1, Evan M. Matros, MD, MMSc1, Joseph H. Dayan, MD1, Joseph J. Disa, MD1, Peter G. Cordeiro, MD1, Babak J. Mehrara, MD1, Andrea L. Pusic, MD2, Jonas A. Nelson, MD1.
1Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
Psychiatric diagnosis (PD) commonly affects patients with a cancer diagnosis and are understood to significantly impact quality of life (QOL). This study aims to demonstrate PD impact and influence satisfaction and QOL following postmastectomy breast reconstruction (PMR).
Women who underwent either implant or autologous-based PMR and completed at least one BREAST-Q from 2009-2017 were included. PDs were categorized into 11 general categories based on DSM-IV criteria. Score distributions for breast satisfaction were cross-sectionally analyzed preoperatively and postoperatively at six months-three-years using non-parametric tests.
Of 3268 included patients, 1860 (56.92%) carried a PD. Of those with a diagnosis, 52% had one diagnosed PD, 29% had two PDs, and 19% had three or more PDs. Anxiety disorders were the most prevalent (n=1398[75.16%]), followed by mood disorders (n= 731[39.3%]). At each time-point, PD patients were significantly less satisfied with their breasts compared to no-PD patients (p<0.01, Table 1). Satisfaction scores progressively decreased as the number of PD diagnoses per patient increased (p<0.05). PD were associated with lower physical-wellbeing of the chest scores preoperatively and postoperatively.
PD have the potential to negatively impact breast satisfaction and physical wellbeing in reconstructive patients. Such patients may benefit from directed psychiatry referrals to offer improved treatment for their PD, which will potentially impact multiple aspects of the patients life and satisfaction with her cancer and reconstructive care.
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