Breast conservation versus mastectomy

Distress sequelae as a function of choice

S. M. Levy, R. B. Herberman, J. K. Lee, Marc E Lippman, T. d'Angelo

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70% of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P < .03). For example, they were significantly more distressed over time (F = 5.5, P < .02), and more depressed in general (F = 9.2, P < .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P < .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when 'choice' played a major role, the conservation patients were psychologically worse off - at least at 3-month's follow-up. If there was a biological advantage, it would have favored the conservation group. However, the psychological prospective data showed just the opposite pattern. The assumption that a woman is psychologically better off opting for breast conservation may need to be re-examined.

Original languageEnglish
Pages (from-to)367-375
Number of pages9
JournalJournal of Clinical Oncology
Volume7
Issue number3
StatePublished - Jan 1 1989
Externally publishedYes

Fingerprint

Mastectomy
Breast
National Cancer Institute (U.S.)
Radiotherapy
Multivariate Analysis
Breast Neoplasms
Drug Therapy
Demography
Radiation
Psychology
Biopsy
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Levy, S. M., Herberman, R. B., Lee, J. K., Lippman, M. E., & d'Angelo, T. (1989). Breast conservation versus mastectomy: Distress sequelae as a function of choice. Journal of Clinical Oncology, 7(3), 367-375.

Breast conservation versus mastectomy : Distress sequelae as a function of choice. / Levy, S. M.; Herberman, R. B.; Lee, J. K.; Lippman, Marc E; d'Angelo, T.

In: Journal of Clinical Oncology, Vol. 7, No. 3, 01.01.1989, p. 367-375.

Research output: Contribution to journalArticle

Levy, SM, Herberman, RB, Lee, JK, Lippman, ME & d'Angelo, T 1989, 'Breast conservation versus mastectomy: Distress sequelae as a function of choice', Journal of Clinical Oncology, vol. 7, no. 3, pp. 367-375.
Levy SM, Herberman RB, Lee JK, Lippman ME, d'Angelo T. Breast conservation versus mastectomy: Distress sequelae as a function of choice. Journal of Clinical Oncology. 1989 Jan 1;7(3):367-375.
Levy, S. M. ; Herberman, R. B. ; Lee, J. K. ; Lippman, Marc E ; d'Angelo, T. / Breast conservation versus mastectomy : Distress sequelae as a function of choice. In: Journal of Clinical Oncology. 1989 ; Vol. 7, No. 3. pp. 367-375.
@article{aa9c00100cdf4458b39af6f6c9abc097,
title = "Breast conservation versus mastectomy: Distress sequelae as a function of choice",
abstract = "Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70{\%} of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P < .03). For example, they were significantly more distressed over time (F = 5.5, P < .02), and more depressed in general (F = 9.2, P < .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P < .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when 'choice' played a major role, the conservation patients were psychologically worse off - at least at 3-month's follow-up. If there was a biological advantage, it would have favored the conservation group. However, the psychological prospective data showed just the opposite pattern. The assumption that a woman is psychologically better off opting for breast conservation may need to be re-examined.",
author = "Levy, {S. M.} and Herberman, {R. B.} and Lee, {J. K.} and Lippman, {Marc E} and T. d'Angelo",
year = "1989",
month = "1",
day = "1",
language = "English",
volume = "7",
pages = "367--375",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "3",

}

TY - JOUR

T1 - Breast conservation versus mastectomy

T2 - Distress sequelae as a function of choice

AU - Levy, S. M.

AU - Herberman, R. B.

AU - Lee, J. K.

AU - Lippman, Marc E

AU - d'Angelo, T.

PY - 1989/1/1

Y1 - 1989/1/1

N2 - Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70% of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P < .03). For example, they were significantly more distressed over time (F = 5.5, P < .02), and more depressed in general (F = 9.2, P < .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P < .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when 'choice' played a major role, the conservation patients were psychologically worse off - at least at 3-month's follow-up. If there was a biological advantage, it would have favored the conservation group. However, the psychological prospective data showed just the opposite pattern. The assumption that a woman is psychologically better off opting for breast conservation may need to be re-examined.

AB - Between 1981 and 1984, 93 stage I and II breast cancer patients were entered onto a trial at the National Cancer Institute (NCI) randomizing patients to excisional biopsy plus radiation v mastectomy. Between 1984 and 1987, 98 stage I and II breast cancer patients were entered onto a behavioral study in Pittsburgh, approximately 70% of whom elected to have breast conservation surgery. Patients at both sites were assessed three to five days postsurgery, and again at 3-month's follow-up, using a well-validated mood measure, the Profile of Mood States (POMS). There were no demographic or disease differences between the two samples. In the Pittsburgh sample, using a repeated measures multivariate analysis of covariance (MANCOVA) analysis, after adjusting for menopausal status and radiotherapy and chemotherapy toxicity, the conservation group was psychologically worse off (F = 2.7, P < .03). For example, they were significantly more distressed over time (F = 5.5, P < .02), and more depressed in general (F = 9.2, P < .005). Using Karnofsky ratings, the two groups were identical in terms of disability at 3-month's follow-up. In contrast, for the NCI patients participating in the randomized trial, after adjusting for chemotherapy and radiotherapy treatments, reported overall distress decreased over time (F = 17.4, P < .0001) for all patients, irrespective of treatment group, and the between-groups MANCOVA was not significant. Thus, when comparing the two samples, when 'choice' played a major role, the conservation patients were psychologically worse off - at least at 3-month's follow-up. If there was a biological advantage, it would have favored the conservation group. However, the psychological prospective data showed just the opposite pattern. The assumption that a woman is psychologically better off opting for breast conservation may need to be re-examined.

UR - http://www.scopus.com/inward/record.url?scp=0024592339&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024592339&partnerID=8YFLogxK

M3 - Article

VL - 7

SP - 367

EP - 375

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 3

ER -