Abstract P4-09-07: Psychological impact of type of breast cancer surgery: A national cohort study

Abstract

Abstract Background Type of breast surgery and breast reconstruction after mastectomy may affect the psychological well-being of breast cancer patients. The present study assessed the impact of different types of breast surgery on rates of psychological disorders in breast cancer patients. Patients & Methods This nationwide cohort study, based on Korean Health Insurance Review and Assessment Service (HIRA) claims data, included 26,259 patients who were diagnosed with invasive breast cancer and underwent surgery from June 1, 2017, to December 31, 2018. Associations between the incidence of psychological disorders and variables such as type of breast cancer surgery, patient age, and insurance type were evaluated by univariable and multivariable time dependent Cox regression analyses. Results Of the 26,259 patients, 9,394 (35.8%) underwent total mastectomy (TM) and 16,865 (64.2%) underwent partial mastectomy (PM); of the former, 4,056 (43.2%) underwent breast reconstruction surgery (RS). The median follow-up time for all patients was 194 days (interquartile range 74-334 days). A total of 4685 patients (17.84%) were newly diagnosed with psychological disorders after breast cancer surgery. Multivariable analysis showed that axillary lymph node dissection (ALND) was significantly associated with increased rates of overall psychological disorders (hazard ratio [HR] 1.337 p<0.0001), depression (HR 1.124 p=0.0462), anxiety (HR 1.459, p<0.0001) and insomnia (HR 1.238, p<0.0001). The rates of overall psychological disorders (HR 0.889, p=0.0002) and insomnia (HR 0.897, p=0.01) were significantly lower in patients who underwent TM than PM. The rates of overall psychological disorders (HR 0.837, p=0.0001) and insomnia (HR 0.831, p=0.0021) were also significantly lower in patients who underwent TM followed by RS than in patients who underwent PM. RS tended to reduce the rate of overall psychological disorders in patients who underwent TM. Subgroup analysis showed that, compared with PM, RS after TM significantly reduced the incidence of insomnia in younger patients (<50 years) and those who underwent sentinel lymph node biopsy (SLNBx). Conclusion In contrast to general belief, rates of overall psychological disorders and insomnia were higher in patients who underwent PM than TM. Compared with PM, RS after TM resulted in significantly lower rates of psychological disorders and insomnia in younger patients (age <50 years) and those who underwent SLNBx at a median < 1 year postoperatively. ALND was associated with increased rates of overall psychological disorders, depression, anxiety and insomnia. Citation Format: Soo Kyung Ahn, Sohee Oh, Jongjin Kim, Jung-Seok Choi, Ki-Tae Hwang. Psychological impact of type of breast cancer surgery: A national cohort study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-07.