A prospective study on the impact of surgical treatment on postoperative quality of life and mediating factors in breast cancer patients
10.7659/j.issn.1005-6947.250248
- VernacularTitle:外科手术对乳腺癌患者术后生活质量的影响及中介因素的前瞻性研究
- Author:
Qingxian XU
1
;
Yuan LI
;
Maoshan CHEN
;
Shi WANG
;
Wei RONG
;
Lei YANG
;
Tingyue HUANG
;
Heng YIN
;
Jun FAN
;
Wei XU
;
Qiuling SHI
;
Hongwei YANG
Author Information
1. 遵义医科大学护理学院,贵州 遵义 563000;四川省遂宁市中心医院 乳腺甲状腺外科,四川 遂宁 629000
- Publication Type:Journal Article
- Keywords:
Breast Neoplasms;
Surgical Procedures,Operative;
Patient Reported Outcome Measures;
Quality of Life;
Mediation Analysis
- From:
Chinese Journal of General Surgery
2025;34(5):978-987
- CountryChina
- Language:Chinese
-
Abstract:
Background and Aims:Surgical treatment is a cornerstone of breast cancer management;however,the physical trauma and psychological burden associated with surgery may adversely affect patients'quality of life(QoL).Based on data from a prospective cohort,this study was conducted to evaluate changes in postoperative QoL among breast cancer patients and to identify mediating factors influencing QoL,thereby providing evidence for perioperative rehabilitation strategies.Methods:Female breast cancer patients who underwent local surgical treatment at Suining Central Hospital between June 2024 and January 2025 were enrolled.The Constant-Murley Shoulder Score,EORTC QLQ-C30,and QLQ-BR23 questionnaires were used pre-and postoperatively to assess shoulder joint function,and QoL.Paired t-tests were used to analyze changes in scores before and after surgery.A mediation model was applied to explore the indirect pathways through which surgery impacts QoL.Additionally,subgroup analyses were conducted to compare QoL changes across different surgical modalities.Results:A total of 148 patients were included,with median age of 54(46-60)years old Postoperative psychological health significantly improved,while shoulder function and overall QoL scores markedly declined(all P<0.001).According to QLQ-C30,functional domains such as physical and role functioning worsened,while symptom burden increased.The QLQ-BR23 revealed significantly higher scores for breast and upper limb symptoms postoperatively(both P<0.001).Subgroup analyses showed that patients undergoing axillary lymph node dissection experienced greater declines in shoulder function and QoL compared to those receiving sentinel lymph node biopsy(both P<0.05).QoL deterioration was comparable between mastectomy and breast-conserving surgery,although the former was associated with more prominent pain and breast symptoms.Mediation analysis indicated that shoulder function,breast symptoms,and physical functioning served as mediators in the impact of surgery on QoL,while better psychological health exerted a protective effect.Conclusion:Surgical treatment significantly affects postoperative QoL in breast cancer patients,with local functional impairment and symptom exacerbation serving as key mediators.Different surgical approaches have varying impacts on QoL.Enhancing postoperative shoulder rehabilitation,symptom management,and psychological support may improve patients'QoL.
