Poster Presentation Cancer Survivorship 2019

The impact of breast reconstruction surgery decision-making on body image outcomes in women with breast cancer: a qualitative study (#246)

Lorna Huang 1 , Sarah Guinta 1 , Natasha Hatcher 1 , Ilona Juraskova 2 , Rebekah Laidsaar-Powell 2 , Danielle Muscat 3 , Susan Carroll 4 5 , Catriona McNeil 4 6 , Lucinda Burke 6 , Pamela Howson 7 , Belinda Chan 6 8 , Haryana Dhillon 2 9
  1. School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
  2. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
  3. Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
  4. Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, NSW, Australia
  5. Northern Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
  6. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  7. Dept of Breast Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
  8. Strathfield Private Hospital, Strathfield, NSW
  9. Psycho-Oncology Cooperative Research Group, University of Sydney, NSW, Australia

Background: Different types of post-mastectomy breast reconstruction (BR) have differing implications for adjuvant cancer treatment, complications, and cosmetic and disease outcomes. Body image has been a primary measure of the outcomes of treatment in previous literature, given its role in informing women’s psychosocial well-being.

Aims: To: (1) explore women’s experiences of immediate or delayed BR postmastectomy, with or without radiation therapy, and how these decisions shaped body image outcomes; (2) examine whether Cash’s (2012) cognitive-behavioural model of body image could explain their experiences.

Methods: Semi-structured qualitative interviews were conducted via telephone July to September, 2018. Participants were recruited from social media, the Breast Cancer Network of Australia’s Research and Survey Register, and Sydney hospitals. They included Australian women who had completed primary breast cancer treatment, spoke English and provided consent. Interviews were transcribed, and analysed thematically using a Framework approach.

Results:  There were 26 participants (median age = 57 years, range = 33–76): 11 had immediate BR, eight delayed, seven no BR; and 12 had postmastectomy radiotherapy. Nine themes were identified, with few variations found between different treatment types. Themes highlighted the complex interaction of clinician communication, health system concerns, non-cancer specific life stressors, patient characteristics and integrated care shaping decision-making, outcome evaluation and body image in the context of post-mastectomy breast reconstruction. From this, a novel model was developed to understand the interactions between the themes. Cash’s model of body image only partially accounts for body image adjustment, which had a bi-directional relationship with decision evaluation.

 

Conclusion: Current models of body image and decision-making in breast cancer settings are too simplistic and focused on short-term outcomes. They need to incorporate a broader range of concerns to accurately reflect women’s experience and develop appropriate decision-making tools and interventions to support women through their breast cancer journey.