One hundred and twenty patients consented to participate in this study. The mean age of patients was 47.35 (SD10.67) years, and the time since diagnosis was 23.69 (SD20.38) months. Around half of the patients were of Sistani ethnicity (52.8%), followed by Baluch (40.8%) and others (6.7%). Three-fourth of patients were married (75.8), and most were housewives (88.3%). 16.3% of patients had a family history of breast cancer. At the time of the survey, 40.8% of patients had been diagnosed with stage III breast cancer, followed by 34.2% stage IV, 22.5% stage II, 2.5% stage I. Most (90%) of patients had received chemotherapy, and 64.2% received radiotherapy. More than half of the patients underwent mastectomy (53.3%), followed by underwent lumpectomy (34.2%), and 12.5% had not been surgery (table1).
Based on the results of Chi-square analysis, patients who underwent lumpectomy more had received radiotherapy than patients who underwent a mastectomy and not surgical (χ2= 6.22, p=0.04). Most patients who underwent mastectomy had stage III, stage VI of disease (χ2=15.62, p=0.004).
Quality of Life
In the functioning scale, the higher mean scores were for body image (78.61, SD=26.69) and future perspective (55.27, SD=26.81), respectively, while the lower mean scores were for sexual enjoyment (14.86, SD=16.84) and sexual functioning (14.16, SD=17.63). On the other hand, on the symptom scale, upset by hair loss (49.16, SD=38.88) and systematic therapy side effects (45, SD=17.42) scored the highest, followed by arm symptoms (30.83, SD=26.73) and breast symptoms (13.63, SD=18.58).
The significant difference across surgical groups was present in the functioning scales (body image, sexual functioning, and sexual enjoyment) and symptom scales (arm symptom). Patients who underwent lumpectomy had the best sexual function, sexual enjoyment, and body image. On the other hand, patients who underwent mastectomy had severe arm symptoms compared to patients who underwent a lumpectomy. After adjustment for the type of treatment (radiotherapy) and stage of the disease, this finding remained significant.
Perceived Social Support (MPSS)
The mean score of total social support was 45.71 (SD=9.92). Patients reported that they received the highest level of support from their family (mean=18.02, SD=2.76), followed by significant other (mean=14.45, SD=4.27) and friends (mean=13.23, SD=5.21). The statistical analysis showed that perceived social support's mean score and its domains had no significant difference among surgical groups (p<0.05). The finding was uninfluenced even after controlling covariates (table2).
Coping Strategies and Illness Adjustment
Patients who participated in this study used reasonable efforts coping strategy (mean=4.07, SD=0.35) more than avoidance (mean=3.39, SD=0.55) and emotional turmoil coping strategies (mean=2.93, SD=0.55). Also, patients presented a high degree of adjustment with their illness (mean=150.91, SD=16.29). Patients who underwent lumpectomy used more reasonable effort coping strategies (p=0.009) and had a higher adjustment with illness (p=0.01) than patients who underwent a mastectomy. These differences were still significant after adjustment for the covariate. The degree of illness adjustment in patients who underwent lumpectomy than those who underwent a mastectomy was not different (table2).
Table 1: Demographic characteristics of patients: in general and by Type of Surgery
Variables
|
Overall(N=120)
N (%)
|
Lumpectomy(N=41)
N (%)
|
Mastectomy(N=64)
N (%)
|
No Surgical(N=15)
N (%)
|
P-value
|
Age
|
|
|
|
|
|
mean ± SD
|
47.35 ±10.67
|
46.32 ± 10.55
|
48.08 ± 10.51
|
47.07 ± 12.09
|
0.71
|
≤50
|
75 (62.5)
|
28 (68.3)
|
37 (57.8)
|
10 (66.7)
|
0.52
|
> 50
|
45 (37.5)
|
13 (31.7)
|
27 (42.2)
|
5 (33.3)
|
|
Time of since diagnosis
|
|
|
|
|
|
mean ± SD
|
23.69 ± 20.38
|
19.15 ± 17.61
|
27.73 ± 21.72
|
18.87 ± 18.99
|
0.08
|
6 >
|
22(18.3)
|
8 (19.5)
|
10 (15.6)
|
4 (26.7)
|
0.33
|
6-12
|
43 (35.8)
|
17 (41.5)
|
20 (31.2)
|
6 (40)
|
|
24-12
|
17 (14.2)
|
8 (19.5)
|
8 (12.5)
|
1 (6.7)
|
|
24 <
|
38 (31.7)
|
8 (19.5)
|
26 (40.6)
|
4 (26.7)
|
|
Marital status
|
|
|
|
|
|
Married
|
113 (94.2)
|
40 (97.6)
|
60 (93.8)
|
13 (86.7)
|
0.29
|
Un married
|
7 (5.8)
|
1 (2.4)
|
4 (6.2)
|
2 (13.3)
|
|
Educational level
|
|
|
|
|
|
Primary or lower School
|
64 (53.3)
|
17 (41.5)
|
39 (60.9)
|
8 (53.3)
|
0.16
|
Secondary- High School
|
43 (35.8)
|
16 (39)
|
21 (32.8)
|
6 (40)
|
|
College
|
13 (10.8)
|
8 (19.5)
|
4 (6.2)
|
1 (6.7)
|
|
Ethnicity
|
|
|
|
|
|
sistan
|
63 (52.5)
|
23 (56.1)
|
33 (51.6)
|
7 (46.7)
|
0.71
|
baluch
|
49 (40.8)
|
15 (36.6)
|
26 (40.6)
|
8 (53.3)
|
|
other
|
8 (6.7)
|
3 (7.3)
|
5 (7.8)
|
0 (0)
|
|
Level of income
|
|
|
|
|
|
Equal to expenditures
|
33.3))40
|
19 (46.3)
|
17 (26.6)
|
4 (26.7)
|
0.09
|
Lower than expenditures
|
80 (66.7)
|
22 (53.7)
|
47 (73.4)
|
11 (73.3)
|
|
Place of residence
|
|
|
|
|
|
urban
|
93 (77.5)
|
33 (80.5)
|
47 (73.4)
|
13 (86.7)
|
0.46
|
rural
|
27 (22.5)
|
8 (19.5)
|
17 (26.6)
|
2 (13.3)
|
|
Employed status
|
|
|
|
|
|
housewife
|
106 (88.3)
|
33 (80.5)
|
60 (93.8)
|
13 (86.7)
|
0.11
|
Employed
|
14 (11.7)
|
8 (19.5)
|
4 (6.2)
|
2 (13.3)
|
|
Menopausal status
|
|
|
|
|
|
Pre menopause
|
73 (60.8)
|
15 (36.6)
|
26 (40.6)
|
6 (40)
|
0.91
|
Post menopause
|
47 (39.2)
|
26 (63.4)
|
38 (59.4)
|
9 (60)
|
|
Stage of disease
|
|
|
|
|
|
Stage I, Stage II
|
30 (25)
|
17 (41.5)
|
13 (20.3)
|
0 (0)
|
0.004
|
Stage III
|
49 (40.8)
|
17 (41.5)
|
26 (40.6)
|
6 (40)
|
|
Stage IV
|
41 (34.2)
|
7 (17.1)
|
25 (39.1)
|
9 (60)
|
|
Family history of breast cancer
|
|
|
|
|
|
yes
|
(16.3) 16
|
6 (14.6)
|
10 (15.6)
|
0(0)
|
0.26
|
no
|
(86.7) 104
|
35 (85.4)
|
54 (84.4)
|
15 (100)
|
|
Type of treatment
|
|
|
|
|
|
Chemotherapy
|
|
|
|
|
|
yes
|
113 (94.2)
|
37 (90.2)
|
61 (95.3)
|
15 (100)
|
0.32
|
no
|
7 (5.8)
|
4 (9.8)
|
3 (4.7)
|
0 (0)
|
|
Radiotherapy
|
|
|
|
|
|
yes
|
77 (64.2)
|
31 (75.6)
|
40 (62.5)
|
6 (40)
|
0.04
|
no
|
43 (35.8)
|
10 (24.4)
|
24 (37.5)
|
9 (60)
|
|
Table 2: Average scores of Quality of Life, Perceived Social Support, Coping Strategies in the total patient and according to Type of Surgery
|
Overall (N=120)
(M ± SD)
|
Lumpectomy(N=41)
(M ± SD)
|
Mastectomy(N=64)
(M ± SD)
|
No Surgical(N=15)
(M ± SD)
|
P-value
|
Adjusted
P-value h
|
BR23 functional scales c
|
|
|
|
|
|
|
Body Image
|
78.61 ±26.69
|
91.05 ± 16.07
|
67.44 ± 28.97
|
92.22 ± 17.94
|
0.001b
|
0.001
|
Sexual functioning
|
14.86 ±16.84
|
20.32 ± 17.28
|
11.97 ± 16.12
|
12.22 ± 16.01
|
0.03b
|
0.006
|
Sexual enjoyment
|
14.16 ± 17.63
|
19.51 ± 18.22
|
11.97 ± 17.17
|
8.88 ± 15.25
|
0.04b
|
0.04
|
Future perspective
|
55.27 ± 26.71
|
60.97 ± 25.71
|
50.52 ± 25.88
|
60 ± 31.37
|
0.11b
|
0.16
|
BR23 Symptom Scales d
|
|
|
|
|
|
|
Systemic therapy side effects
|
45 ± 17.42
|
47.85 ± 15.64
|
45.16 ± 17.93
|
36.50 ± 18.23
|
0.08b
|
0.18
|
Breast symptoms
|
13.68 ± 18.58
|
18.29 ± 19.82
|
11.45 ± 18.15
|
10.55 ± 15.25
|
0.05b
|
0.1
|
Arm symptoms
|
30.83 ± 26.73
|
29.26 ± 27.41
|
35.24 ± 26.89
|
16.29 ± 18.71
|
0.03b
|
0.007
|
Upset by hair loss
|
49.16 ± 38.88
|
47.15 ± 36.49
|
48.43 ± 40.25
|
57.77 ± 40.75
|
0.65b
|
0.31
|
MSPSS
|
|
|
|
|
|
|
Family
|
18.02 ± 2.76
|
18.48 ± 2.55
|
17.90 ± 2.22
|
17.26 ± 4.80
|
0.15b
|
0.3
|
Friends
|
13.23 ± 5.21
|
14.60 ± 4.47
|
12.31 ± 5.31
|
13.40 ± 6.16
|
0.13b
|
0.2
|
significant other
|
14.45 ± 4.27
|
15.07 ± 3.87
|
13.93 ± 4.41
|
15 ± 4.72
|
0.31b
|
0.2
|
Total score of social support
|
± 9.9245.71
|
48.17 ± 8.53
|
44.15 ± 9.68
|
45.66 ± 13.31
|
0.12a
|
0.3
|
Coping Strategies
|
|
|
|
|
|
|
Emotional turmoil
|
2.93 ± 0.55
|
2.82 ± 0.52
|
3.03 ± 0.52
|
2.83 ± 0.72
|
0.13a
|
0.11
|
Reasonable efforts
|
4.07± 0.35
|
4.19 ± 0.34
|
4 ± 0.28
|
4.02 ± 0.53
|
0.01a
|
0.02
|
Avoidance
|
3.39 ± 0.55
|
3.40 ± 0.52
|
3.40 ± 0.53
|
3.34 ± 0.69
|
0.92a
|
0.8
|
Illness Adjustment
|
150.91 ± 16.29
|
155.58 ± 2.56
|
147.40 ± 1.83
|
153.13 ± 5.12
|
0.03b
|
0.1
|
a P-value based on ANOVA tests. b P-value based on Kruskal Wallis tests. c For functional scales, higher scores indicate better functioning, d For symptom scales, higher scores indicate worse functioning,h p-value adjusted with radiotherapy and stage of the disease