Klifto Kevin M, Bekheet Faraah N, Manahan Michele A, Broderick Kristen P, Cooney Damon S, Rosson Gedge D, Cooney Carisa M
Plastic and Reconstructive Surgery, University of Missouri, Columbia, USA.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2021 Oct 11;13(10):e18675. doi: 10.7759/cureus.18675. eCollection 2021 Oct.
Background A personal history of depression prior to breast cancer diagnosis and its effect on post-diagnosis quality of life (QOL) in women undergoing breast reconstruction is relatively unknown. We performed the current study to determine if depression alters QOL for patients who undergo breast reconstruction by assessing the pre-to-post-operative change in patient-reported BREAST-Q scores. Methodology We conducted a single-center, post-hoc analysis of 300 patients with completed BREAST-Q data who underwent breast reconstruction from November 2013 to November 2016 following a diagnosis of breast cancer. Patients completed the BREAST-Q at four time points: pre-operatively, six weeks following tissue expander (TE) insertion for patients undergoing staged reconstruction, and six and 12 months following the final reconstruction. Medical records were reviewed to identify patients who had a pre-cancer diagnosis of clinical depression and/or anti-depressant medication use. BREAST-Q scores were compared between groups and within groups. Groups compared were the depression (n = 50) and no depression (n = 250) patients, along with anti-depressant (n = 36) and no anti-depressant (n = 14) use in the depression group. Results Within-group Sexual Well-being scores at the six-week post-TE follow-up for patients in the depression group (median = 37, interquartile range [IQR] = 25-47) were significantly lower (p < 0.01) than the scores for patients in the no depression group (median = 47, IQR = 39-60). There were no statistically significant differences in BREAST-Q scores in other domains. When compared to patients diagnosed with depression who were not taking anti-depressants, anti-depressant medication use did not result in statistically significant higher BREAST-Q scores, although Satisfaction With Breasts six months post-operatively, Psychosocial Well-being at six weeks post-TE, Sexual Well-being at six weeks post-TE and six months post-operatively were clinically higher in patients taking anti-depressants for depression. Conclusions Patients with a diagnosis of depression prior to breast cancer had lower BREAST-Q Sexual Well-being scores in the six-week TE group with or without anti-depressant medication. Patients with a pre-cancer diagnosis of depression considering TEs may benefit from additional counseling prior to breast reconstruction or electing a different method of breast reconstruction. Anti-depressant medications may provide clinically higher BREAST-Q scores in patients with a pre-cancer diagnosis of depression. Adding an anti-depressant medication to a patient's treatment plan may provide additional benefits. Larger samples are required to properly determine the impact of anti-depressant medications on BREAST-Q scores in patients with a pre-cancer diagnosis of depression.
乳腺癌诊断前的抑郁症个人史及其对接受乳房重建的女性诊断后生活质量（QOL）的影响相对未知。我们进行了本研究，通过评估患者报告的BREAST-Q评分术前至术后的变化，来确定抑郁症是否会改变接受乳房重建患者的生活质量。
我们对2013年11月至2016年11月期间因乳腺癌诊断而接受乳房重建且有完整BREAST-Q数据的300例患者进行了单中心事后分析。患者在四个时间点完成BREAST-Q评分：术前；对于接受分期重建的患者，在组织扩张器（TE）植入后六周；以及在最终重建后六个月和十二个月。查阅医疗记录以识别癌症诊断前有临床抑郁症和/或使用抗抑郁药的患者。比较组间和组内的BREAST-Q评分。比较的组为抑郁症患者（n = 50）和无抑郁症患者（n = 250），以及抑郁症组中使用抗抑郁药的患者（n = 36）和未使用抗抑郁药的患者（n = 14）。
抑郁症组患者在TE植入后六周时的组内性健康评分（中位数 = 37，四分位间距[IQR] = 25 - 47）显著低于无抑郁症组患者的评分（中位数 = 47，IQR = 39 - 60）（p < 0.01）。其他领域的BREAST-Q评分无统计学显著差异。与未服用抗抑郁药的抑郁症诊断患者相比，使用抗抑郁药并未导致BREAST-Q评分在统计学上显著更高，尽管术后六个月的乳房满意度、TE植入后六周的心理社会幸福感、TE植入后六周和术后六个月的性健康在服用抗抑郁药治疗抑郁症的患者中临床上更高。
乳腺癌诊断前患有抑郁症的患者，无论是否使用抗抑郁药，在六周TE组中的BREAST-Q性健康评分较低。考虑使用TE的癌症诊断前患有抑郁症的患者，在乳房重建前或选择不同的乳房重建方法时，可能会从额外的咨询中受益。抗抑郁药可能会使癌症诊断前患有抑郁症的患者在临床上获得更高的BREAST-Q评分。在患者的治疗计划中添加抗抑郁药可能会带来额外的益处。需要更大的样本量来正确确定抗抑郁药对癌症诊断前患有抑郁症患者BREAST-Q评分的影响。
