精神科诊断对乳腺癌根治术后患者报告的满意度和生活质量的影响。
The Impact of Psychiatric Diagnoses on Patient-reported Satisfaction and Quality of Life in Postmastectomy Breast Reconstruction.
机构信息
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
Ann Surg. 2023 Jun 1;277(6):e1313-e1323. doi: 10.1097/SLA.0000000000005478. Epub 2022 Jul 6.
OBJECTIVE
The purpose of this study was to determine the prevalence of psychiatric diagnoses among a sample of breast reconstruction patients and measure the association between these diagnoses and reconstruction-related, patient-reported outcomes.
BACKGROUND
The impact of psychiatric disorders in conjunction with breast cancer diagnosis, treatment, and reconstruction have the potential to cause significant patient distress but remains not well understood.
METHODS
A retrospective review of postmastectomy breast reconstruction patients from 2007 to 2018 at Memorial Sloan Kettering Cancer Center was conducted. Patient demographics, comorbidities, cancer characteristics, psychiatric diagnoses, and BREAST-Q Reconstruction Module scores (measuring satisfaction with breast, well-being of the chest, psychosocial, and sexual well-being) at postoperative years 1 to 3 were examined. Mixed-effects models and cross-sectional linear regressions were conducted to measure the effect of psychiatric diagnostic class type and number on scores.
RESULTS
Of 7414 total patients, 50.1% had at least 1 psychiatric diagnosis. Patients with any psychiatric diagnoses before reconstruction had significantly lower BREAST-Q scores for all domains at all time points. Anxiety (50%) and depression (27.6%) disorders were the most prevalent and had the greatest impact on BREAST-Q scores. Patients with a greater number of psychiatric diagnostic classes had significantly worse patient-reported outcomes compared with patients with no psychiatric diagnosis. Psychosocial (β: -7.29; 95% confidence interval: -8.67, -5.91), and sexual well-being (β: -7.99; 95% confidence interval: -9.57, -6.40) were most sensitive to the impact of psychiatric diagnoses.
CONCLUSIONS
Mental health status is associated with psychosocial and sexual well-being after breast reconstruction surgery as measured with the BREAST-Q. Future research will need to determine what interventions (eg, screening, early referral) can help improve outcomes for breast cancer patients with psychiatric disorders undergoing breast reconstruction.
目的
本研究旨在确定乳房重建患者样本中的精神科诊断患病率，并衡量这些诊断与重建相关的患者报告结果之间的关联。
背景
精神障碍与乳腺癌诊断、治疗和重建相结合的影响有可能给患者带来严重的痛苦，但仍未得到充分理解。
方法
对 2007 年至 2018 年在纪念斯隆凯特琳癌症中心接受乳房切除术乳房重建的患者进行了回顾性研究。检查了患者的人口统计学、合并症、癌症特征、精神科诊断以及术后 1 至 3 年的 BREAST-Q 重建模块评分（衡量乳房满意度、胸部健康状况、心理社会和性健康）。采用混合效应模型和横断面线性回归来衡量精神科诊断类别类型和数量对评分的影响。
结果
在 7414 名患者中，50.1%至少有一种精神科诊断。在重建前有任何精神科诊断的患者在所有时间点的所有领域的 BREAST-Q 评分均明显较低。焦虑（50%）和抑郁（27.6%）障碍最为常见，对 BREAST-Q 评分的影响最大。与没有精神科诊断的患者相比，有更多精神科诊断类别的患者的患者报告结果明显更差。心理社会（β：-7.29；95%置信区间：-8.67，-5.91）和性健康（β：-7.99；95%置信区间：-9.57，-6.40）对精神科诊断的影响最敏感。
结论
心理健康状况与乳房重建手术后的心理社会和性健康状况相关，这是通过 BREAST-Q 来衡量的。未来的研究需要确定哪些干预措施（例如，筛查、早期转介）可以帮助改善接受乳房重建的患有精神障碍的乳腺癌患者的结局。
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