Type of publication:
*Lake B., *Fuller H.R., *Rastall S., *Usman T.
Cancer Research, February 2016, vol./is. 76/4 SUPPL. 1(no pagination)
Cancer survivorship is the process of living through and beyond cancer; a key part is how a patient copes with their diagnosis. Breast cancer is the most common malignancy of women worldwide and is known to be a severe stressor. Research has determined that the coping strategies used by women with breast cancer are vital to adjustment to their disease. Immediate breast reconstruction at the time of mastectomy with preservation of the breast form has been shown to be a positive influence on breast cancer patients however there are currently no studies to show whether breast reconstruction changes mechanisms of coping for such patients. The aim of this study, therefore, was to conduct a prospective cohort study to determine whether immediate breast reconstruction following mastectomy changes the way women with breast cancer cope with their diagnosis, compared to those who have mastectomy alone.
A standardised questionnaire, the Brief Cope Scale was sent to two cohorts of patients who had a mastectomy and immediate reconstruction or mastectomy alone over an 11 year period 2003 to 2014 in Shropshire, England. It is a 28-point item with a four point Likert scale, which measures 14 different coping mechanisms: self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning humour, acceptance, religion and self-blame. The inclusion criteria for this study was all woman who had mastectomy with immediate breast reconstruction in Shropshire between 2003 and 2014 for either Ductal carcinoma in situ (DCIS) or breast cancer which was node negative (cohort 1). The principle exclusion criteria were: men, node positive cancer, prophylactic mastectomy and breast reconstruction. Each index patient was matched for year of diagnosis, adjuvant therapy and age to woman who had mastectomy alone for DCIS or breast cancer which was node negative (cohort 2). An anonymous questionnaire was sent out to all patients identified who were still living, with a reminder letter at six weeks.
Questionnaires were sent to a total of 234 patients; 117 patients in each cohort. Preliminary results indicate a response rate of 46%, with 60 responses from reconstruction cohort and 48 from mastectomy. The mean age was 50, with range 29 to 70 for reconstruction cohort, and the mean age of mastectomy cohort was 52, with range 32 to 70. Common coping styles for the reconstruction cohort were acceptance, active coping and use of emotional support. Common coping styles for mastectomy cohort were acceptance, use of emotional support and positive reframing. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.88 at P value 0.02). Significantly less patients coped by active venting in reconstructive cohort compared to mastectomy cohort; (T value 1.91 at P value 0.03).
Breast reconstruction alters coping mechanisms in breast cancer patients allowing less venting coping style and more active coping. Understanding how breast surgery changes coping mechanisms allows clinicians to understand cancer survivorship in breast cancer patients and helps to provide needed support.