"Peace of Mind" After Mastectomy: A Scoping Review

Area of Science:

• Oncology
• Surgical Oncology
• Psychosocial Oncology

Background:

• Many women eligible for breast conservation therapy (BCT) opt for mastectomy (unilateral mastectomy [UM] or contralateral prophylactic mastectomy [CPM]) citing a desire for "peace of mind."
• The concept of "peace of mind" remains poorly defined and inconsistently measured in relation to surgical choices for breast cancer treatment.

Purpose of the Study:

• To characterize the definition and measurement of "peace of mind" in the context of surgical decisions for breast cancer.
• To examine the relationship between "peace of mind" and the choice between BCT, UM, and CPM.

Main Methods:

• A systematic literature search was conducted across nine databases up to October 8, 2023.
• Data were extracted from 20 studies meeting predefined inclusion criteria, with a focus on prospective cohort studies.

Main Results:

• "Peace of mind" was rarely explicitly defined, often described indirectly through the absence of "anxiety," "fear," or "concern."
• Most studies (90%) indirectly measured "peace of mind" using validated questionnaires for psychological distress at multiple postoperative time points.
• The majority of studies (95%) found no statistically significant difference in "peace of mind" between BCT, UM, and CPM at the latest assessment points.

Conclusions:

• "Peace of mind" in breast cancer treatment decisions is frequently conceptualized by the absence of negative emotions like anxiety and fear.
• Current evidence indicates comparable levels of "peace of mind" among average-risk women undergoing BCT, UM, or CPM.
• Shared surgical decision-making should consider the comparable emotional and psychosocial well-being offered by CPM and breast conservation strategies.