Decision making in early breast cancer: Factors influencing patient’s choice of surgery and its impact on psychosocial wellbeing and quality of life

Abstract

Background: Breast conservation treatment (BCT) is the standard of care in early breast cancer, but acceptance of BCT has been slow in Indian women. However, much has changed in the landscape of breast cancer in India in the last two decades. To understand how decision-making dynamics have changed, this study was designed to evaluate factors which influence treatment decisions in patients with early breast cancer (EBC), and impact of their choice on psychosocial adjustment and quality of life. Methodology: This cross-sectional study was conducted on patients of EBC (N=137)who underwent surgery in a public healthcare setting during the period of 2018-2022. Patients were asked to fill up a self-designed questionnaire aboutfactors which influenced their choice of breast cancer surgery. BREAST Q (Psychosocialwellbeing) and FACT-B questionnaire, were used to assess their psychosocial adjustment and quality of life. Results: Amongst 96 participants who fulfilled inclusion criteria and completed the study, 43% had undergone breast conservation surgery (BCS), and 57% modified radical mastectomy (MRM).Awareness about surgical treatment options was generally low (36.5%).Patients undergoing BCS were younger and had higher socioeconomic status. As regards decision making, factors which mattered most included: surgeon’s recommendation (76%) and expertise (78%); fear of recurrence after BCS (73%); concern about body image (62.5%); risk of re-do surgery (62.5%).  Patients own choice, husband’s advice, experience of others played equivocal role in making the decision, while concern about radiation, expense of treatment, or more complicated surgery mattered the least. BCS had a higher Breast Q mean score of 84.17±14.51 as compared to 72.81±15.92 of MRM group (p=0.0005). Women with BCS fared better on items about body image and confidence in social settings, but scored less on emotional health. However, as regards QOL, the mean FACT-B scores were 122.62±23.33 for BCS group and 120.32±16.41for MRM (p=0.57). Conclusion: BCS is finding increasing acceptance in the Indian patients. Surgeon’s recommendation is the most decisive factor while making a decision. Though Psychosocial adjustment of patients with BCT is better, the overall QOL of patients choosing either type of treatment is comparable.

Keywords: decision making in early breast cancer