Sydney Medical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia; Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia; School of Medicine and Public Health, Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia.
Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, University of Sydney, Camperdown, NSW, Australia.
Breast. 2019 Aug;46:25-31. doi: 10.1016/j.breast.2019.04.003. Epub 2019 Apr 20.
Neoadjuvant systemic therapy (NAST) is used for large operable or highly proliferative breast cancers. It is not known whether psychological outcomes differ according to the treatment sequence (chemotherapy or surgery first) or tumour response.
This was a planned analysis of a multi-institutional single arm longitudinal study of patients considering NAST for operable breast cancer. Participants completed patient reported outcome questionnaires before and after the decision about NAST, between chemotherapy and surgery, and 12 months after diagnosis.
Fifty-nine women enrolled. Fourteen of 51 (28%) who received NAST experienced pathological complete response (pCR). Patients who had surgery first (n = 7) had higher baseline anxiety, and a greater decrease in anxiety at 12 months follow up, compared with patients who received NAST (n = 50) (a decrease from baseline of 34 pts vs 17 points; p = 0.033). Distress declined at a similar rate in surgery first and NAST groups. Mean satisfaction with decision score post-decision was significantly lower in the adjuvant group compared with NAST (22 vs 26, p = 0.02). No differences were seen between patients with pCR vs residual cancer in: distress, anxiety, satisfaction with decision, fear of progression, and decision regret.
Most patients in this study proceeded with NAST when their surgeon offered it as an option. This exploratory analysis suggests that patients who chose surgery first tended to be more anxious, and had lower satisfaction with their decision, than those who had NAST. In patients who had NAST, lack of pCR does not appear to correlate with adverse psychological outcomes.
新辅助全身治疗（NAST）用于可手术或高度增殖性乳腺癌。尚不清楚根据治疗顺序（化疗或手术）或肿瘤反应，心理结局是否存在差异。
这是对考虑接受新辅助全身治疗的可手术乳腺癌患者进行的多机构单臂纵向研究的计划分析。参与者在决定接受新辅助治疗前后、化疗和手术之间以及诊断后 12 个月，完成了患者报告的结局问卷。
59 名女性入组。51 名接受 NAST 的患者中有 14 名（28%）发生了病理完全缓解（pCR）。先手术（n=7）的患者基线焦虑较高，与接受 NAST 的患者（n=50）相比，12 个月随访时焦虑下降幅度更大（从基线下降 34 分比 17 分；p=0.033）。先手术和 NAST 组的痛苦程度下降速度相似。决策后，辅助治疗组的平均决策满意度评分明显低于 NAST 组（22 分比 26 分，p=0.02）。在 pCR 与残留癌症患者中，未观察到焦虑、满意度、对进展的恐惧和决策后悔等方面的差异。
本研究中的大多数患者在其外科医生提供选择时选择了 NAST。这项探索性分析表明，选择先手术的患者往往比接受 NAST 的患者更焦虑，对决策的满意度更低。在接受 NAST 的患者中，pCR 缺失似乎与不良心理结局无关。
