Are preoperative sexual well-being and breast satisfaction associated with the decision making in patients with early-stage breast cancer undergoing oncologic surgery?
Authors: Lee Yi , Aldecoa Kim Abbegail Tan , Padmanabhan Dakshin , Salamatov Esentur , Frame Megan , El-Magbri Mariam , Selim Caroline , Deptula Lisa , Mbionwu Chioma S. , Kirby Amy , Goodman Judie R. 
Published: June 2023

e12573

Background: Early-stage breast cancer is treated with lumpectomy with radiation therapy or mastectomy in the absence of medical contraindications. Patients have the autonomy to pursue the surgery of their choice. However, the associations between patients’ decisions on surgery (lumpectomy vs. mastectomy) and their preoperative sexual wellbeing and breast satisfaction remain largely unknown. We investigated early-stage breast cancer patients’ preoperative sexual wellbeing and breast satisfaction who underwent lumpectomy vs. mastectomy using the validated and widely used BREAST-Q questionnaire. Secondary aim described the expectations and concerns through qualitative methods. Methods: This is a study using BREAST-Q to investigate early-stage breast cancer patients’ preoperative sexual wellbeing and breast satisfaction at a university-affiliated community hospital between October 2022 and February 2023. Structured telephone interviews with open-ended questions conducted. All patients received preoperative teaching regarding current guideline-directed treatment. Multivariate logistic regression analysis examined factors predictive of surgery and two-sample t-test for baseline characteristics. Statistical analyses were performed using Stata/IC 16.1. Results: A total of 109 patients were screened, 6 patients declined, and 22 patients were eligible for enrollment. 90.1% were White, 9.1% were Black. We identified 68.8% of patients agreed to undergo lumpectomy; 87.5% expressed that the decision was based on total trust for the multidisciplinary team, whereas 12.5% based on personal decision. 70% underwent lumpectomy and 20% mastectomy, among which two were recommended mastectomy by physicians' clinical judgement, two elected mastectomy in the hope for no cancer recurrence. Preoperative sexual wellbeing score (48.4 vs 53, p = 0.74) and breast satisfaction score (60.2 vs 69.2, p = 0.39) showed no difference in lumpectomy vs mastectomy. The multivariate logistic regression model adjusted for baseline demographics (age, race, BMI, bra size), relationship status, and socioeconomic status (education and annual personal income) indicated that no independent factors predictive of decisions. Patients reported answers to open-ended questions revealed the following most common expectations were 42.8% cancer free, 28.5% fast recovery, meanwhile concerns were 38.1% cancer recurrence, 28.6% surgical complications, 9.5% breast appearance. Conclusions: Our study shows that most patients made trust-based decisions despite available information and preoperative teaching. Patients' preoperative sexual wellbeing and breast satisfaction had no association with patients' decisions in lumpectomy vs. mastectomy. No social determinants associated with patients' decision making were identified.