Assessment of Quality of Life in Patients of Mastectomy With Chemotherapy.

Abstract

Background: Breast cancer is one of the most common cancers in India as well as the world. In India, 48% of patients with breast cancer are below 50 years of age, indicating a huge age shift in the last 25 years. Breast cancer in an early age group increased the five-year survival rate and increased life expectancy has created a large group of breast cancer survivors who battle scars of disease as well as treatment. Standardized multimodal treatment is either not affordable or not available, so the breast conservation surgery rate is very low. Mastectomy is still the most common modality of treatment, particularly in rural areas. In addition to psychological, social, economic, and family barriers to obtaining the diagnosis and treatment needed, economic barriers like the cost of travel and lost wages are important factors influencing the choice of treatment. Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QOL) of women so treated, with or without breast reconstruction. Conflicting literature is available regarding QOL after mastectomy. The survival rates of breast cancer are increasing. They are reported in the range of 80-90% in western countries while in the range of 60% in the Indian scenario. With high survival rates in cancer, the focus needs to shift from mortality indicators to QOL indicators. The QOL that these survivors experience is a comparatively newer domain of study. Though there are many instruments for assessment of breast QOL of breast cancer patients with numerous studies in western literature, QOL studies in Indian rural population are far less, and urban studies cannot be extrapolated because the method of treatment differs, with breast conservation being more common in urban population. Hence, the present study is undertaken to assess the QOL in patients who have undergone mastectomy and ongoing chemotherapy or completed chemotherapy recently using a relatively newer instrument, i.e., the Quality of Life Instrument - Breast Cancer Patient version.Methodology: The present study was a cross-sectional study conducted at a rural tertiary healthcare center on mastectomy patients attending the outpatient department and admitted to the hospital. All the female patients of carcinoma breast treated with a mastectomy who were receiving the adjuvant or neoadjuvant chemotherapy or were within one year of completion of chemotherapy irrespective of age at diagnosis were included in this study. The assessment was performed by interview method using a questionnaire.Results: In this study, 44.90% of the patients were <50 years old and 55.10% were more than 50 years old. Among them, 28.57% were illiterate while only 20.41% had graduate education. The majority (61.22%) were from the low socioeconomic class. Majority of women presented in the late stages of the disease, with 61.22% presenting in the third stage and only three (6.12%) presenting in the first stage of the disease. The overall global QOL score was 49 ± 2.6 and fear was assessed. Patients scored better in the physical, psychological, social, and spiritual domains, with an average score of more than 50. The worst scores were observed among distress of illness or treatment.Conclusions: The present study shows that the average QOL scores in rural Indian women after mastectomy are moderate. Global scores and other indicators show moderate QOL.