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By Ananth Ravi, PhD, MCCPM, Chief Science and Clinical Officer, MOLLI Surgical
A breast cancer diagnosis is stressful and the surgical treatment for cancer — whether it’s mastectomy or lumpectomy — contributes to that stress and anxiety. The experience can be so traumatic that an estimated 5-35% of patients are at increased risk of some degree of post-traumatic stress disorder (PTSD) in addition to their illness. In fact, the younger the patient, the higher the risk of developing PTSD symptoms, such as hyper-vigilance, intrusive thoughts, anxiety, and depression. But on a more hopeful note, younger patients have been shown to experience improved post-traumatic growth, meaning they rebound well from the experience, ultimately.
In a study by researchers at Ludwig-Maximilians-Universitaet (LMU), it was revealed that “receiving a breast cancer diagnosis often has a stronger psychological impact than experiencing other types of severe trauma, such as a serious accident or a violent assault. Over half of the breast cancer patients in the study still suffered from at least one symptom of PTSD one year after diagnosis.” Most women with breast cancer need some form of surgery as part of their treatment, and breast cancer surgery has come a long way.
Ultimately, the trauma of a breast cancer diagnosis may be inescapable. We have made amazing strides in treatment, but the news that “you have cancer” is always going to have a traumatic effect. That fact is also worth remembering and reflecting upon when we work with a newly diagnosed person.
And the question for us is not, perhaps, “how will we lessen the trauma,” but rather “given that the patient is experiencing a trauma, what can we do to improve the experience to the best of our abilities?” And truthfully, we have made greater strides in the clinical treatment of cancer than we have in improving the patient experience.
There are a myriad of answers to that question, but there are two areas that — in my experience at least — are effective and manageable ways of improving the patient experience for people with breast cancer.
Provide education on all options
When it comes to breast cancer surgery, the treatment is only part of the approach. Patients need to be seen and heard in their decision-making process, supported with resources such as mentors, and given the information they need so that whatever choice they make will be the right one for them. As they process the news of their diagnosis, patients must quickly understand complicated information about options, treatments, and timelines, at the same time as they process all the emotions associated with a diagnosis.
If cancer is found a lumpectomy, mastectomy, or bilateral mastectomy may be indicated. Each comes with its own set of options and considerations. For example, if breast-conserving lumpectomy is possible, the next decision will be how to localize. There are currently three main localization techniques in use: wire-guided localization, wire-free magnetic localization, or radioactive seed localization. Wire-free magnetic localization provides the accuracy and effectiveness of wire-free without the concerns around radiation exposure (and nuclear medicine isn’t available in all centers due to its increased overhead costs). Clinical trials have verified the effectiveness of this approach, and other studies have shown reductions in cost and increases in patient satisfaction.
While understanding the medical implications of each surgical option is important, the quality of life implications and resonance with patient values is equally important. That doesn’t mean the choice is easy. According to one study, where support is needed most is in the decision-making process. That’s why giving patients the opportunity to raise concerns, talk through fears, and taking the time needed to consider outcomes with family, friends, as well as physicians, is an important part of lowering fear and anxiety. According to the study, “These findings point to the importance of helping patients have realistic expectations before surgery. It also suggests that pain management should be a priority for improving patient-reported outcomes after mastectomy.”
When physicians explain all treatment options and work collaboratively with patients to make decisions, patients feel more satisfied with their choices.
Shorten preoperative time
“Adam Woo, a consultant in pain and anesthesia at King’s College Hospital in London, has worked with thousands of patients dealing with pain. Patients with high levels of anxiety tend to be more sensitive to pain, he has found,” reports the New York Times in “How Pain Tolerance and Anxiety Seem to Be Connected.” Though the research is ongoing, it can be concluded that our felt experiences — both physical and emotional — are linked. We can improve the patient experience by addressing both, and creating an efficient, calming preoperative environment. Where delays (and the resulting suspense) can’t be avoided, prioritizing clear communication about what is happening and when can help keep patients as calm as possible. Wire-free localization techniques can help here as well as they alleviate the stress of scheduling relative to the OR schedule. Once placed, you have up to 30 days with MOLLI Surgical’s magnetic seed localization technique; rather than the same-day requirements of wire-guided localization.
As I began my journey in developing wire-free, magnetic marker technology, one patient stands out in my memory. She said she had arrived at the hospital first thing in the morning, and clinicians placed a wire into her breast. The woman had been fasting for 24 hours because she was scheduled to have surgery that day. The problem is that the hospital where she was waiting for her procedure is a very busy trauma center, so her surgery kept getting delayed. She had to sit in pain with this wire in place, anxious, not knowing when she was going into the OR. Her story drove home the need for a simple, patient-centric, alternative. With MOLLI, she could have had her localization procedure and then gone home to resume her life comfortably before returning to the OR at her surgery time, decoupled from other departments’ schedules.
A recent study looked at the preference for oncoplastic reconstruction for cancers that are large, which conventionally would have been treated with mastectomy, that can now be treated with oncoplastic techniques and achieve the same outcomes but with a better self-assessment score from patients.
Oncoplastic surgery combines breast cancer tumor removal (lumpectomy) with plastic surgery techniques. Again, wire-free localization techniques offer surgeons more flexibility to make incisions where they want in order to reduce visible scars. The precision of magnetic or radioactive seed localization means surgeons can take less tissue, leaving a more cosmetically satisfactory outcome, while still achieving clean margins.
Educating patients about all of their options is an important part of reducing their trauma. A cancer diagnosis brings understandable anxiety, and anxiety creates urgency — most patients feel they want the lesion out as quickly as possible. Research shows that patients have a hard time predicting their future satisfaction in the face of an unfamiliar procedure. This misprediction leads to feelings of regret. In every case, showing compassion for patients’ anxiety in the short term, reassuring them that they have time to think, and educating them on their options and explaining to them what to expect in terms of outcomes can help reduce trauma in the long run.
Female breast cancer is the most commonly diagnosed cancer in the world. Breast cancer affects millions of people, and millions of families by extension. By focusing on these two strategies, physicians and technologists can create a better breast cancer experience for patients and their communities.