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1.
Ann Surg ; 277(6): e1313-e1323, 2023 06 01.
Article in English | MEDLINE | ID: mdl-35793069

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the prevalence of psychiatric diagnoses among a sample of breast reconstruction patients and measure the association between these diagnoses and reconstruction-related, patient-reported outcomes. BACKGROUND: The impact of psychiatric disorders in conjunction with breast cancer diagnosis, treatment, and reconstruction have the potential to cause significant patient distress but remains not well understood. METHODS: A retrospective review of postmastectomy breast reconstruction patients from 2007 to 2018 at Memorial Sloan Kettering Cancer Center was conducted. Patient demographics, comorbidities, cancer characteristics, psychiatric diagnoses, and BREAST-Q Reconstruction Module scores (measuring satisfaction with breast, well-being of the chest, psychosocial, and sexual well-being) at postoperative years 1 to 3 were examined. Mixed-effects models and cross-sectional linear regressions were conducted to measure the effect of psychiatric diagnostic class type and number on scores. RESULTS: Of 7414 total patients, 50.1% had at least 1 psychiatric diagnosis. Patients with any psychiatric diagnoses before reconstruction had significantly lower BREAST-Q scores for all domains at all time points. Anxiety (50%) and depression (27.6%) disorders were the most prevalent and had the greatest impact on BREAST-Q scores. Patients with a greater number of psychiatric diagnostic classes had significantly worse patient-reported outcomes compared with patients with no psychiatric diagnosis. Psychosocial (ß: -7.29; 95% confidence interval: -8.67, -5.91), and sexual well-being (ß: -7.99; 95% confidence interval: -9.57, -6.40) were most sensitive to the impact of psychiatric diagnoses. CONCLUSIONS: Mental health status is associated with psychosocial and sexual well-being after breast reconstruction surgery as measured with the BREAST-Q. Future research will need to determine what interventions (eg, screening, early referral) can help improve outcomes for breast cancer patients with psychiatric disorders undergoing breast reconstruction.


Subject(s)
Breast Neoplasms , Mammaplasty , Mental Disorders , Humans , Female , Breast Neoplasms/etiology , Mastectomy/adverse effects , Patient Satisfaction , Quality of Life , Cross-Sectional Studies , Mammaplasty/adverse effects , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Patient Reported Outcome Measures , Personal Satisfaction
2.
JCO Oncol Pract ; 17(3): e369-e376, 2021 Mar.
Article in English | MEDLINE | ID: mdl-32853121

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient's concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.


Subject(s)
COVID-19 , Cancer Care Facilities , Ethics Consultation/trends , Neoplasms , Resuscitation Orders/ethics , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell , Cardiopulmonary Resuscitation/ethics , Child , Decision Making , Ethics Committees, Clinical , Female , Health Care Rationing/ethics , Hematologic Neoplasms , Humans , Intensive Care Units , Intubation, Intratracheal/ethics , Kidney Neoplasms , Lung Neoplasms , Male , Medical Futility , Mental Competency , Middle Aged , Multiple Myeloma , New York City , Occupational Health/ethics , Patients' Rooms , Personal Autonomy , Proxy , SARS-CoV-2 , Sarcoma , Young Adult
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