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 Dr. Bellino |
MEASURING QUALITY OF LIFE In a recent study, Dr. Bellino and colleagues evaluated the clinical and personality characteristics related to quality of life in 57 women who underwent breast reconstructive surgery following mastectomy.
Psychometric evaluation included a semistructured interview for demographic and clinical characteristics; the Temperament and Character Inventory; the Inventory of Interpersonal Problems; the Short Form Health Survey Questionnaire; the Severity Item of the Clinical Global Impression; the Hamilton Depression Rating Scale; and the Hamilton Anxiety Rating Scale. An assessment with the Short Form was repeated three months after breast reconstruction.
Results showed that those patients who were assessed with the temperamental characteristic of "harm avoidance" and characterized as "apprehensive and doubtful" scored high in their quality of life scores. According to Dr. Bellino, the restoration of their body image helped them reduce social anxiety and insecurity.
Similarly, those patients who were evaluated as "vindictive and self-centered" on a scale of interpersonal problems also had high quality of life scores.
According to Dr. Bellino, patients with a "vindictive and self-centered" model of interpersonal relationship are "resentful and aggressive," and here, breast reconstruction could symbolize the conclusion of a reparative process and fulfill the desire of revenge on cancer.
None of the other psychological or other factors evaluated, including the characteristics of the cancer and its treatment, were significantly related to quality of life scores.
"Overall, all of the patients in our study showed significant improvements in quality of life following breast reconstruction surgery. With very few exceptions, breast reconstruction following mastectomy has a positive impact on quality of life. However, the positive psychological effects can be differentiated in relation to individual characteristics, begging the need for a closer care for these patients," Dr. Bellino says.
PATIENT EDUCATION Immediate reconstruction is currently considered the standard of care in post-mastectomy patients. According to Dr. Bellino, it is better to perform a mastectomy and breast reconstruction in the same procedure, in order to shorten the period in which patients have to suffer the psychological consequences of a change in their body image as a consequence of illness.
Patients who can receive breast reconstruction should be carefully assessed with psychometric evaluation tools, and a detailed personality profile should be investigated and established, Dr. Bellino says.
"Available evidence on the effects of personality and relational factors on the outcome of reconstruction should be the object of a complete information of patients, in order to allow them to give their informed consensus to treatment procedures with a full and updated knowledge of the effects of reconstruction on long-term functionality and quality of life," Dr. Bellino says.
According to Dr. Bellino, physicians should take into account personality issues and their effects on treatment outcome in these patients. They should be able to listen to patients and their problems to accept functional consequences of interventions.
"Here, we believe that a better and more structured interspecialty cooperation with psychiatry is clearly needed to deal with these problems," Dr. Bellino says.
Disclosures:
Dr. Bellino reports no relevant financial interests.
