Understanding decision-making for and against oncoplastic breast-conserving surgery as an alternative to a mastectomy in early breast cancer: UK ANTHEM qualitative study.

Autor:	Davies C; Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK., Conefrey C; Population Health sciences, Bristol medical School, Bristol, UK., Mills N; Population Health sciences, Bristol medical School, Bristol, UK., Fairbrother P; Independent Cancer Patients Voice (ICPV), Bristol, UK., Holcombe C; Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK., Whisker L; Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK., Skillman J; Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK., White P; Applied Statistics Group, University of the West of England, Bristol, UK., MacMillan D; Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK., Comins C; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Hollingworth W; Population Health sciences, Bristol medical School, Bristol, UK., Potter S; Bristol Surgical and Perioperative Care Complex Intervention Collaboration, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, UK.; Bristol Breast Care Centre, Southmead Hospital, Bristol, UK.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2024 Jun 12; Vol. 111 (6).
DOI:	10.1093/bjs/znae133
Abstrakt:	Background: Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when breast-conserving options are offered. The aim of the ANTHEM qualitative study was to explore factors influencing women's surgical decision-making for and against oncoplastic breast-conserving surgery. Methods: Semi-structured interviews were conducted with a purposive sample of women who had received either oncoplastic breast-conserving surgery or a mastectomy with or without immediate breast reconstruction to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically. Trial registration number: ISRCTN18238549. Results: A total of 27 women from 12 centres were interviewed. Out of these, 12 had chosen oncoplastic breast-conserving surgery and 15 had chosen a mastectomy with or without immediate breast reconstruction. Overwhelmingly, women's decisions were guided by their surgical teams. Decision-making for and against oncoplastic breast-conserving surgery was influenced by three key inter-related factors: perceptions of oncological safety; the importance of maintaining/restoring femininity and body image; and practical issues. Oncological safety was paramount. Women who reported feeling reassured that oncoplastic breast-conserving surgery was oncologically safe were happy to choose this option. Those who were not reassured were more likely to opt for a mastectomy, as a perceived 'safer' option. Most women wished to maintain/restore femininity, with the offer of immediate breast reconstruction essential to make a mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern. Conclusion: Decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options, including appropriate reassurance about the short- and long-term oncological safety of oncoplastic breast-conserving surgery is vital if women are to make fully informed decisions. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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