The Comparative Study Of Quality Of Life And Psychosocial Adaptability After Modified Radical Mastectomy And Breast Reconstruction

Objective:The clinical data and follow-up data of patients with breast cancer after modified radical mastectomy and breast reconstruction were retrospectively analyzed to understand the metastasis,recurrence and death of patients.To understand the changes of postoperative quality of life,psychosocial adaptability,marital status and employment status of patients in the two groups;The differences in quality of life and psychosocial adaptability between the two groups were compared by propensity matching.Methods:This study retrospectively collected the data of breast cancer patients who underwent modified radical mastectomy or breast reconstruction from2014 to 2020,and divided them into the breast reconstruction group and the modified radical mastectomy group according to the surgical method.The patients were invited to fill in the questionnaire through telephone or wechat follow-up,and the data were analyzed by IBM SPSS 25.0 software.BMI,monthly family income,operation time and other variables of the two groups were matched by 1:1 propensity score.Counting data were described by frequency or percentage,FACT-B score was represented by mean ± standard deviation,AND PAQ score was represented by median(interquartile spacing).Rank-sum test or test was used to compare the general data of patients in the two groups,and the treatment effect(recurrence and metastasis),employment status and marriage status of patients in the two groups were compared by the test.FACT-B scores were compared between the two groups by two independent sample T tests.PAQ scores of 2 groups were compared by Wilcoxon rank-sum test in nonparametric test.Results:1.A total of 1738 patients were reviewed,including 274 patients who died,3 patients who participated in clinical trials,88 patients with incomplete medical records,57 patients with incomplete follow-up data,and 1316 patients were finally included.After matching propensity score,there was no statistical significance in other general information except operative time and payment method(P>0.05).2.The proportions of postoperative recurrence and metastasis were 4.3% and2.2% in the reconstruction group,and 2.7% and 5.1% in the modified group.After matching the propensity score,there was no statistical significance in the recurrence and metastasis of the two groups(P>0.05).3.The rate of returning to work in the reconstruction group was 61.6%,and the divorce rate was 6.5%,while that in the improvement group was 35% and 1.1%,respectively.After matching the propensity score,there was no statistical significance in the changes of employment and marriage relationship between the two groups(P>0.05).4.The quality of life of the two groups was at a moderate level.After matching with propensity score,the total score of FACT-B,physiological status,emotional status and additional attention of the reconstruction group were higher than those of the improvement group,with statistical significance(P<0.05),but there was no difference in social/family status and functional status(P>0.05).5.Two groups of psychological social adaptation ability are in moderate adaptation level,and after propensity score matching,reconstruction group total score of PAQ,anxiety/depression,self-esteem and self-acceptance,attitudes,self control and self-efficacy is higher than the improved group,difference has statistical significance(P<0.05),but in the sense of belonging dimensions have no difference(P>0.05).Conclusions:On the basis of ensuring the therapeutic effect,breast reconstruction can retain the appearance of breast to the maximum extent,and the integrity of body image can increase the self-acceptance and self-identity of patients,reduce the psychological burden of patients,improve the physical condition of patients,and help patients obtain better quality of life and psychosocial adaptability.