Deshpande Vaishnavi P, Shinde Raju K, Deo Deepali, Hippargekar Prashant, Venurkar Shreya V
Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.
Department of Community Medicine, Swami Ramanand Teerth Rural Government Medical College, Ambajogai, IND.
Cureus. 2022 Aug 5;14(8):e27703. doi: 10.7759/cureus.27703. eCollection 2022 Aug.
Breast cancer is one of the most common cancers in India as well as the world. In India, 48% of patients with breast cancer are below 50 years of age, indicating a huge age shift in the last 25 years. Breast cancer in an early age group increased the five-year survival rate and increased life expectancy has created a large group of breast cancer survivors who battle scars of disease as well as treatment. Standardized multimodal treatment is either not affordable or not available, so the breast conservation surgery rate is very low. Mastectomy is still the most common modality of treatment, particularly in rural areas. In addition to psychological, social, economic, and family barriers to obtaining the diagnosis and treatment needed, economic barriers like the cost of travel and lost wages are important factors influencing the choice of treatment. Mastectomy represents a deep burden for women with breast cancer. Very little is known about the psychological consequences over time and the quality of life (QOL) of women so treated, with or without breast reconstruction. Conflicting literature is available regarding QOL after mastectomy. The survival rates of breast cancer are increasing. They are reported in the range of 80-90% in western countries while in the range of 60% in the Indian scenario. With high survival rates in cancer, the focus needs to shift from mortality indicators to QOL indicators. The QOL that these survivors experience is a comparatively newer domain of study. Though there are many instruments for assessment of breast QOL of breast cancer patients with numerous studies in western literature, QOL studies in Indian rural population are far less, and urban studies cannot be extrapolated because the method of treatment differs, with breast conservation being more common in urban population. Hence, the present study is undertaken to assess the QOL in patients who have undergone mastectomy and ongoing chemotherapy or completed chemotherapy recently using a relatively newer instrument, i.e., the Quality of Life Instrument - Breast Cancer Patient version.
The present study was a cross-sectional study conducted at a rural tertiary healthcare center on mastectomy patients attending the outpatient department and admitted to the hospital. All the female patients of carcinoma breast treated with a mastectomy who were receiving the adjuvant or neoadjuvant chemotherapy or were within one year of completion of chemotherapy irrespective of age at diagnosis were included in this study. The assessment was performed by interview method using a questionnaire.
In this study, 44.90% of the patients were <50 years old and 55.10% were more than 50 years old. Among them, 28.57% were illiterate while only 20.41% had graduate education. The majority (61.22%) were from the low socioeconomic class. Majority of women presented in the late stages of the disease, with 61.22% presenting in the third stage and only three (6.12%) presenting in the first stage of the disease. The overall global QOL score was 49 ± 2.6 and fear was assessed. Patients scored better in the physical, psychological, social, and spiritual domains, with an average score of more than 50. The worst scores were observed among distress of illness or treatment.
The present study shows that the average QOL scores in rural Indian women after mastectomy are moderate. Global scores and other indicators show moderate QOL.
乳腺癌是印度乃至全球最常见的癌症之一。在印度，48%的乳腺癌患者年龄在50岁以下，这表明在过去25年中出现了巨大的年龄转变。早期乳腺癌患者的五年生存率提高，预期寿命延长，这造就了一大批乳腺癌幸存者，他们既要与疾病的创伤作斗争，也要应对治疗带来的影响。标准化的多模式治疗要么费用高昂，要么难以获得，因此保乳手术率很低。乳房切除术仍然是最常见的治疗方式，尤其是在农村地区。除了在获得所需诊断和治疗方面存在心理、社会、经济和家庭障碍外，诸如差旅费和工资损失等经济障碍也是影响治疗选择的重要因素。乳房切除术给乳腺癌女性带来了沉重负担。对于接受或未接受乳房重建的此类女性，随着时间推移其心理后果以及生活质量（QOL）鲜为人知。关于乳房切除术后的生活质量，现有文献存在矛盾之处。乳腺癌的生存率在不断提高。西方国家报告的生存率在80%至90%之间，而在印度，这一比例在60%左右。随着癌症生存率的提高，关注点需要从死亡率指标转向生活质量指标。这些幸存者所经历的生活质量是一个相对较新的研究领域。尽管西方文献中有许多关于评估乳腺癌患者乳房生活质量的工具及众多研究，但针对印度农村人口的生活质量研究要少得多，而且城市研究不能外推，因为治疗方法不同，保乳在城市人口中更为常见。因此，本研究旨在使用一种相对较新的工具，即生活质量量表 - 乳腺癌患者版，评估接受乳房切除术且正在进行化疗或最近刚完成化疗的患者的生活质量。
本研究是一项横断面研究，在一家农村三级医疗中心对前来门诊就诊并住院的乳房切除术患者进行。所有接受乳房切除术治疗的乳腺癌女性患者，无论诊断时年龄大小，只要正在接受辅助或新辅助化疗，或在化疗完成后一年内，均纳入本研究。通过问卷调查的访谈方法进行评估。
在本研究中，44.90%的患者年龄小于50岁，55.10%的患者年龄大于50岁。其中，28.57%为文盲，只有20.41%拥有研究生学历。大多数（61.22%）来自社会经济地位较低的阶层。大多数女性在疾病晚期就诊，61.22%处于疾病第三阶段，只有3名（6.12%）处于疾病第一阶段。评估了总体全球生活质量得分，为49±2.6。患者在身体、心理、社会和精神领域得分较好，平均得分超过50分。在疾病或治疗困扰方面得分最差。
本研究表明，印度农村女性乳房切除术后的平均生活质量得分中等。全球得分和其他指标显示生活质量中等。
