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Breast Cancer Treatment in Older Women: Does Getting What You Want Improve Your Long-Term Body Image and Mental Health?

From the Department of Oncology, Cancer Control Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC; and Office of Cancer Survivorship, National Cancer Institute, Rockville, MD

Address reprint requests to Jeanne S. Mandelblatt, MD, Lombardi Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Ave, Ste 317, Washington, DC 20007; e-mail: mandelbj{at}georgetown.edu

PURPOSE: Little is known about the impact of surgical treatment on body image and health outcomes in older breast cancer patients. The purpose of this article is to evaluate whether concordance between treatment received and treatment preferences predicts posttreatment body image and whether body image, in turn, affects mental health in older women with breast cancer 2 years after treatment.

PATIENTS AND METHODS: A longitudinal cohort of 563 women who were 67 years old or older and who had stages I and II breast cancer were surveyed by telephone at 3, 12, and 24 months after surgery. All women were clinically eligible for breast conservation. Body image was measured using questions adapted from the Cancer Rehabilitation Evaluation System–Short Form, and mental health was evaluated using a Medical Outcomes Study subscale.

RESULTS: Body image was an important factor in treatment decisions for 31% of women. Women who received breast conservation had better body image 2 years after treatment than women who had mastectomies (P < .0001). Women who preferred breast conservation but received mastectomy had the poorest body image. Using generalized estimating equations, we found that body image, in turn, predicted 2-year mental health.

CONCLUSION: Body image is important for many older women, and receiving treatment consistent with preferences about appearance was important in long-term mental health outcomes. Health professionals should elicit preferences about appearance from women and provide treatment choices in concordance with these preferences. Enhancing shared decision making has the potential to improve mental health in older breast cancer survivors.

Supported by grant No. R01 HS 08395 from the Agency for Health Care Policy and Research, grant No. DAMD17-94-J-4212 from the Department of the Army, grant No. K05 CA 96940 from the National Cancer Institute, and grant No. 1U10 CA 84131 from the National Institute on Aging.

Presented in part at the 24th Annual Meeting of the Society of Behavioral Medicine, Salt Lake City, UT, March 19-22, 2003.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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