BACKGROUND

Psychiatric conditions are known to impact outcomes in breast reconstruction patients, but their effect on patient-reported outcomes in breast-conserving surgery (BCS) patients remains unclear. This study investigates how psychiatric diagnoses-both preexisting and post-cancer-affect BREAST-Q scores in BCS patients.

METHODS

We conducted a retrospective review of patients who underwent BCS from 2017-2022 at Memorial Sloan Kettering, examining BREAST-Q scores collected in routine care preoperatively and annually for 3 years postoperatively. Patients were categorized as having no psychiatric diagnosis, a diagnosis before breast cancer, or a diagnosis after. Kruskal-Wallis and Wilcoxon tests compared scores, and multivariable linear mixed effects models adjusted for confounders.

RESULTS

Of 7937 patients, 273 were diagnosed before breast cancer, 2971 were diagnosed after, and 4693 had no history of psychiatric diagnosis. Among those with a psychiatric diagnosis, 81% had anxiety. Compared with patients without psychiatric diagnoses, those with diagnoses-pre- or post-cancer-reported significantly lower scores in Satisfaction with Breasts, Sexual Well-Being, and Psychosocial Well-Being (p < 0.001). No significant difference was observed in Physical Well-Being scores for precancer diagnoses (p = 0.4) compared with patients without psychiatric diagnoses. Precancer diagnoses were associated with more pronounced declines across most domains compared to postcancer diagnoses.

CONCLUSIONS

Psychiatric diagnoses are associated with lower BREAST-Q scores after BCS, especially when diagnosed before cancer. These findings emphasize the importance of integrated mental health support in optimizing quality of life for breast cancer patients.