Higher Distress in Patients with Breast Cancer Is Associated with Declining Breast Reconstruction

Area of Science:

• Oncology
• Surgical Oncology
• Psychosocial Oncology

Background:

• Distress is common in newly diagnosed breast cancer patients, potentially influencing surgical decisions.
• The revised Edmonton Symptom Assessment System (ESAS-r) measures total patient distress.
• No prior studies linked preoperative ESAS-r scores to breast reconstruction choices.

Purpose of the Study:

• To investigate the association between preoperative distress levels and the decision for breast reconstruction in breast cancer patients.
• To determine if higher distress scores predict avoidance of breast reconstruction surgery.

Main Methods:

• Retrospective review of 312 breast cancer patients diagnosed in 2014 at Princess Margaret Cancer Centre.
• Collection of patient and tumor characteristics, and breast reconstruction status.
• Multivariable logistic regression analysis to assess the link between ESAS-r distress scores and reconstruction decisions.

Main Results:

• Higher ESAS-r distress scores were significantly associated with patients choosing not to have breast reconstruction.
• For lumpectomy patients, higher distress increased the odds of forgoing reconstruction (OR 1.034, P=0.025).
• For mastectomy patients, higher distress also increased the odds of forgoing reconstruction (OR 1.031, P=0.023).

Conclusions:

• Elevated preoperative distress, measured by ESAS-r, is linked to a lower likelihood of undergoing breast reconstruction.
• Addressing and treating distress in breast cancer patients may uncover a previously masked desire for reconstruction.
• Breast reconstruction offers significant psychosocial benefits, highlighting the importance of managing patient distress.