| Objective:Applicating PRO tools Breast-Q scale to evaluate the patients reported outcomes by breast cancer patients after mastectomy and BCT plastic surgery,as well as breast cosmetic effects,to investigate the factors affecting satisfaction and quality of life.Method:From January 2014 to January 2019,106 patients who underwent breast cancer surgery in the department of gastrointestinal surgery of the first affiliated hospital of guangxi medical university were collected.According to the surgical method,the patients were divided into two groups:mastectomy group（n=53）and BCT plastic surgery group（n=53）.Clinical data collected included:age（<40、40-50、>50）,BMI（<18.5kg/㎡、18.5-23.9kg/㎡、>23.9kg/㎡）,operation time（before December 2017,after August 2011）marriage status（married,divorced or widowed）,education degree（High school or below,Technical secondary school-junior college,Bachelor degree or above）,tumor site（The four quadrants of the breast）and tumor size（≤2 CM,2.1-5CM）,axillary cleaned（yes,no）,operation method（General breast conserving,volume displacement and reduction mammaplasty OR volume replacement）.Thenwe scoring the cosmetic effect of breast conserving and evaluate the relation of scores and related factors by statistical analysis.P<0.05 was considered statistically significant.Result:1、71 questionnaires were distributed and 53 questionnaires were recovered in the BCT plastic surgery group.The effective follow-up rate was74.6%.In the group of mastectomy,63 questionnaires were distributed and 56questionnaires were recovered.The effective follow-up rate was 88.9%.The average age of patients in the mastectomy group was 49.3 years old（26-66）,while that in the BCT plastic surgery group was 44.6 years old（26-64）.The clinical indexes and statistical characteristics of patients in mastectomy group and BCT plastic surgery group were compared.The results showed that there was no statistically significant difference in BMI,operation time and marital status between mastectomy group and BCT plastic surgery group.Whether in age,tumor size,axillary lymph node cleaning the difference was statistically significant,mastectomy group in the patient’s age>50[49.1%（26/53）]was obviously higher than the proportion of patients with BCT plastic surgery group[28.3%（15/53）](χ2=6.568,P<0.001),in patients with large tumors of the breast（2.1-5cm）[69.8%（37/53）]was obviously higher than the proportion of patients with BCT plastic surgery group[35.8%（19/53）](χ2=12.266,Axillary lymph node dissection was also significantly increased in patients with mastectomy group[47.2%（25/53）][24.5%（13/53）](χ2=5.907,P<0.05).2、According to the BREAST-Q score,the preoperative BREAST satisfaction of patients in the mastectomy group was 69.7±20.1 points,and the postoperative BREAST satisfaction was 46.0±20.7 points,and the postoperative BREAST satisfaction was significantly decreased（p<0.001）.The preoperative quality of life of patients in the mastectomy group was 78.9±15.5 points,75.1±16.2 points and 67.5±21.3 points,respectively.The postoperative quality of life was 63.5±20.2 points,57.1±17.2 points and49.7±23.0 points.The total preoperative quality of life score of patients with total resection was 210.2±36.9 points,and the postoperative quality of life score was 161.9±43.7 points.The total postoperative quality of life score was significantly decreased（p<0.001）.3、Patients with BCT plastic surgery group preoperative breast satisfaction was 60.2±18.4 points,65.7±17.0 points after the surgery,postoperative breast satisfaction rise（t=2.180,p<0.05）,in plastic group of patients with preoperative quality of life,including social psychological health,physical health,sexual health degrees were 76.4±17.8 points,74.8±17.9 points,64.6±18.2points,postoperative was 67.9±21.6 points,60.5±19.8 points,57.0±20.0 points,Postoperative psychosocial health,physical health and sexual health were significantly decreased（p<0.01）.The total score of preoperative quality of life was 215.8±43.0 in the BCT plastic surgery group and185.5±42.0 points in the postoperative group,and the total score of postoperative quality of life was significantly decreased（p<0.001）.4、Preoperative breast satisfaction was 69.7±20.1 points in the mastectomy groupand 60.2±18.4 points in the BCT plastic surgery group,with statistically significant difference（t=2.313,P<0.05）.There were no statistically significant differences in preoperative quality of life,psychosocial health,physical health and sexual health between the two groups（P>0.05）.The postoperative breast satisfaction of patients in the mastectomy group was 46.0±20.7,and that in the BCT plastic surgery group was 65.7±17.0,with statistically significant differences（t=-5.630,P<0.001）.The postoperative quality of life of patients in themastectomy group was 161.9±43.7,and that in the BCT plastic surgery group was 185.5±42.0,with statistically significant differences（t=-2.626,P<0.05）.Among the postoperative care satisfaction scores,the satisfaction scores of the patients in the mastectomy group were generally concentrated.Patients with BCT plastic surgery group had the lowest satisfaction with radiotherapy information,which was 67.9±22.3 points,with the minimum value of 0 points and the maximum value of 100 points.For the satisfaction degree of medical information given by the breast doctor,it is 70.3±19.1 points,with a minimum value of 43 points and a maximum value of 100 points.The satisfaction of patients with nursing staff and other doctors in the BCT plastic surgery group was 96.6±8.0 and 94.4±12.0.5、The rate of excellent and good cosmetic score was 57.1%,with excellent grade accounting for 9.5%and good grade accounting for47.6%.There were no statistically significant differences in clinical indicators of breast cosmetic score,such as age,BMI,surgical method and marital status（p>0.05）.The cosmetic score of patients undergoing BCT plastic surgery after January 2018 was 9.4±2.3,and that before December 2017 was 7.3±3.4,with statistically significant difference（t=-2.239,P<0.05）.Conclusion:BCT plastic surgery guarantees the postoperative quality of life of breast cancer patients to a certain extent.Through the use of BREAST-Q scale,it emphasizes that clinical work should understand patients’cognition and demands from the perspective of patients,and pay attention to the improvement of technology and services.In addition,the feasibility of mutual understanding of postoperative breast satisfaction and life quality of patients through the evaluation of breast beauty. |
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