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. 2024 Aug;31(8):5168-5179.
doi: 10.1245/s10434-024-15360-3. Epub 2024 May 8.

"Peace of Mind" After Mastectomy: A Scoping Review

Safraz A Hamid  1   2 , Baylee Bakkila  3 , Kurt S Schultz  3   4 , Alyssa A Grimshaw  5 , Craig G Gunderson  6 , Elizabeth L Godfrey  3 , Clara Lee  7 , Elizabeth Berger  3 , Shoshana Rosenberg  8 , Rachel A Greenup  3
Affiliations

"Peace of Mind" After Mastectomy: A Scoping Review

Safraz A Hamid et al. Ann Surg Oncol. 2024 Aug.

Abstract

Background: Many women eligible for breast conservation therapy (BCT) elect unilateral mastectomy (UM) with or without contralateral prophylactic mastectomy (CPM) and cite a desire for "peace of mind." This study aimed to characterize how peace of mind is defined and measured and how it relates to surgical choice.

Methods: Nine databases were searched for relevant articles through 8 October 2023, and data were extracted from articles meeting the inclusion criteria.

Results: The inclusion criteria were met by 20 studies. Most were prospective cohort studies (65%, 13/20). In the majority of the studies (72%, 13/18), Non-Hispanic white/Caucasian women comprised 80 % or more of the study's sample. Almost half of the studies used the phrase "peace of mind" in their publication (45%, 9/20), and few directly defined the construct (15%, 3/20). Instead, words representing an absence of peace of mind were common, specifically, "anxiety" (85%, 17/20), "fear" (75%, 15/20), and "concern" (75%, 15/20). Most of the studies (90%, 18/20) measured peace of mind indirectly using questionnaires validated for anxiety, fear, worry, distress, or concern, which were administered at multiple postoperative time points (55%, 11/20). Most of the studies (95%, 18/19) reported at least one statistically significant result showing no difference in peace of mind between BCT, UM, and/or CPM at their latest time of assessment.

Conclusion: Peace of mind is largely framed around concepts that suggest its absence, namely, anxiety, fear, and concern. Existing literature suggests that peace of mind does not differ among average-risk women undergoing BCT, UM, or CPM. Shared surgical decisions should emphasize at least comparable emotional and/or psychosocial well-being between CPM and breast conservation.

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Conflict of interest statement

Disclosures: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372: n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/
Figure 2.
Figure 2.
Proportion of Non-Hispanic White or Caucasian patients in total study sample.
Figure 3.
Figure 3.
Proportion of studies reporting at least one statistically significant result at their latest postoperative assessment that favors either BCT, UM, or CPM or show no difference. Since an individual study may have reported more than one result, the sum in each comparative group may be >100%. BCT = breast conservation therapy; UM = unilateral mastectomy; CPM = contralateral prophylactic mastecotmy
See this image and copyright information in PMC

References

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