Objectives: Breast reconstruction has become an integral part of the treatment of breast cancer, with the aim to reduce patients' impairment in everyday life after oncological demolition. However, literature data indicate that not all the patients are equally satisfied with surgical outcome: while some patients experience a significant improvement in health related quality of life, others develop anxiety or depressive symptoms after the intervention. Anyway, few studies have investigated whether any factors concerning the illness and patient's personality can affect her satisfaction after breast reconstruction. The objective of our study is to examine which clinical characteristics and personality dimensions are related to the change of quality of life (QoL) in patients receiving breast reconstruction after mastectomy. Methods: Patients who had received mastectomy were evaluated in the week before breast reconstruction (T0) with: a semistructured interview for demographic and clinical characteristics, the Temperament and Character Inventory-125 items (TCI-125) for dimensional assessment of personality, the Inventory of Interpersonal Problems-64 items (IIP-64) for evaluating problems in socio-relational functioning, the Short Form Health Survey (SF-36) for the quality of life, the Clinical Global Impression- Severity Item (CGI-S), and Hamilton Scales for Depression and Anxiety (HAM-D, HAM-A). Assessment was repeated after three months (T1) with SF-36. Statistical analysis was performed with Pearson Correlations for continuous variables and Analysis of Variance for categorical variables. Significant variables were included in a regression model, in order to identify which factors were independently related to the change between T0 and T1 of SF-36 score. Results of statistics were significant when p ≤ 0.05. Results: 57 consecutive patients were included. Regression analysis showed that the personality dimension "Harm Avoidance" of TCI and the domain "Vindictive/Self-Centered"of IIP were significantly and independently related to the change of SF-36 score, while no variable concerning cancer nor oncological treatment is related to the change in QoL. Conclusions: According to Cloninger's description, people with high levels of "Harm Avoidance"are characterized by anticipatory worry and pessimism, fear of uncertainty, with a marked tendency to social inhibition. The restoration of a satisfying body image could reduce patients' social anxiety and their worry when facing stress conditions or danger. The "Vindictive/Self- Centered" modality of interpersonal relationship belongs to people characterized by suspiciousness and aggressiveness. In these subjects, the improvement of QoL after breast reconstruction may be related to a desire for revenge on cancer, and the intervention can be seen as an evidence of its defeat. Our results suggest therefore that specific personality dimensions and patterns of interpersonal functioning play a significant role in quality of life of patients who undergo breast reconstruction after mastectomy. These factors should be considered in pre-surgical evaluation. Our findings need to be confirmed by follow-up evaluations of QoL.

La qualità di vita dopo ricostruzione mammaria in pazienti mastectomizzate: gli effetti delle dimensioni di personalità

BELLINO, Silvio;BOGETTI, Paolo;BOGETTO, Filippo
2006-01-01

Abstract

Objectives: Breast reconstruction has become an integral part of the treatment of breast cancer, with the aim to reduce patients' impairment in everyday life after oncological demolition. However, literature data indicate that not all the patients are equally satisfied with surgical outcome: while some patients experience a significant improvement in health related quality of life, others develop anxiety or depressive symptoms after the intervention. Anyway, few studies have investigated whether any factors concerning the illness and patient's personality can affect her satisfaction after breast reconstruction. The objective of our study is to examine which clinical characteristics and personality dimensions are related to the change of quality of life (QoL) in patients receiving breast reconstruction after mastectomy. Methods: Patients who had received mastectomy were evaluated in the week before breast reconstruction (T0) with: a semistructured interview for demographic and clinical characteristics, the Temperament and Character Inventory-125 items (TCI-125) for dimensional assessment of personality, the Inventory of Interpersonal Problems-64 items (IIP-64) for evaluating problems in socio-relational functioning, the Short Form Health Survey (SF-36) for the quality of life, the Clinical Global Impression- Severity Item (CGI-S), and Hamilton Scales for Depression and Anxiety (HAM-D, HAM-A). Assessment was repeated after three months (T1) with SF-36. Statistical analysis was performed with Pearson Correlations for continuous variables and Analysis of Variance for categorical variables. Significant variables were included in a regression model, in order to identify which factors were independently related to the change between T0 and T1 of SF-36 score. Results of statistics were significant when p ≤ 0.05. Results: 57 consecutive patients were included. Regression analysis showed that the personality dimension "Harm Avoidance" of TCI and the domain "Vindictive/Self-Centered"of IIP were significantly and independently related to the change of SF-36 score, while no variable concerning cancer nor oncological treatment is related to the change in QoL. Conclusions: According to Cloninger's description, people with high levels of "Harm Avoidance"are characterized by anticipatory worry and pessimism, fear of uncertainty, with a marked tendency to social inhibition. The restoration of a satisfying body image could reduce patients' social anxiety and their worry when facing stress conditions or danger. The "Vindictive/Self- Centered" modality of interpersonal relationship belongs to people characterized by suspiciousness and aggressiveness. In these subjects, the improvement of QoL after breast reconstruction may be related to a desire for revenge on cancer, and the intervention can be seen as an evidence of its defeat. Our results suggest therefore that specific personality dimensions and patterns of interpersonal functioning play a significant role in quality of life of patients who undergo breast reconstruction after mastectomy. These factors should be considered in pre-surgical evaluation. Our findings need to be confirmed by follow-up evaluations of QoL.
2006
12
54
59
S. BELLINO; P. BOGETTI; E. PARADISO; M. FENOCCHIO; P. PAROLA; E. BAGLIONI; F. BOGETTO
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/42108
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