A Prospective Exploration Of The Quality Of Life And Mental Health Implications Of Mastectomy Alone On Women In Sub-saharan Africa
Sarah H. Kennedy, MD1, Jennifer Hamill, MPH1, Nicholas Berlin, MD, MS, MPH1, Kavitha Ranganathan, MD2, Etsehiwot Haileselassie, MD3, Joseph Oppong, MBBS4, Lisa Newman, MD, MPH5, Edwin Wilkins, MD, MS1, Mahteme Bekele, MD3, Adeyiza Momoh, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2Brigham and Women's Hospital, Boston, MA, USA, 3St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, 4Komfo Anokye Teaching Hospital, Kumasi, Ghana, 5Weill Cornell Medicine, New York, NY, USA.
PURPOSE:Breast cancer is the most common cause of malignancy-related mortality worldwide. Stark disparities in survival in sub-Saharan Africa (SSA) have been attributed to presentation delays. Fears of mastectomy are a prominent reason. This study assesses quality of life and mental health implications of mastectomy in African women.METHODS:Women in Ghana and Ethiopia, with breast cancer undergoing mastectomy were followed prospectively. Demographics, clinical and treatment variables were collected. Breast related quality of life and mental health measures were evaluated preoperatively and six months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Univariate tests and logistic regression analyses evaluated changes in these measures and assessed regional differences.RESULTS:125 women were recruited, 50 from Ghana and 75 from Ethiopia. Over 50% were diagnosed with stage III or IV disease. Radiation was more common in Ghana (p <0.001). At six months, the entire cohort of women reported decreased scores for breast satisfaction (mean difference, -6.0) and sexual well-being (mean difference, -8.7). Ghanaian women reported decreased BREAST-Q scores for all measured satisfaction and quality of life domains and Ethiopian women reported increased scores across the same domains. Women in both countries reported similar significant improvements in anxiety and depression postoperatively.CONCLUSION:This study demonstrates previously undescribed quality of life experiences, with interesting regional variations, amongst women in Ghana and Ethiopia undergoing mastectomy and provides evidence of mental health benefits of mastectomy. This is vital information as we seek to understand reasons for women's fears and work to improve on breast cancer care in SSA.
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