Changes in health-related quality of life following breast cancer surgery: A systematic review of the literature on the role of surgical approaches.

Abstract

Background: This systematic review aimed to examine changes in health-related quality of life (HRQoL) in women with breast cancer from pre-to post surgery, comparing mastectomy (M), mastectomy with breast reconstruction (MBR), and breast conserving surgery (BCS).

Methods: We included English-language randomised and non-randomised controlled trials and observational studies involving adult women, pre-operatively diagnosed with breast cancer (excluding metastatic cases). Studies needed to assess HRQoL pre- and post-surgery using validated questionnaires and include women undergoing M, MBR, and BCS. Searches in six electronic databases were supplemented by checking reference lists. Two independent researchers conducted the article selection, data extraction, and quality assessment. Narrative synthesis included categorisation of HRQoL in physical and psychosocial HRQoL domains with calculation and interpretation of minimally important differences (MID).

Results: Six prospective studies of fair quality (n = 172 to n = 1178, follow-up: 1-120 months) were included. By 24 months, HRQoL, anxiety, and depression either returned to pre-surgery levels or improved for all surgical groups, with comparable outcomes. Physical HRQoL deteriorated following MBR and BCS at 6 months and 12 months post-surgery, respectively, while poor psychosocial HRQoL was prominent following M at 12 months. MBR fared worse in anxiety and depression compared with the other groups.

Discussion: HRQoL challenges are evident following all surgical approaches, albeit at different timepoints along the treatment pathway. The evidence is limited due to a small number of studies and considerable methodological variation. Systematic assessment of HRQoL in routine care is recommended to monitor trajectories throughout the care pathway and guide psychological interventions.