MD Mervi Rautalin, specialist in plastic surgery, investigated in her doctoral thesis how various surgical techniques for breast cancer affect patients’ quality of life. The thesis examines three types of surgical procedures: mastectomy, complete removal of the breast; resection, partial removal of the breast; as well as reconstructive surgeries where a new breast is reconstructed for the patient either immediately in connection with the cancer surgery or at a later date.
The doctoral thesis comprises two studies: Rautalin surveyed the quality of life of 840 patients in various states of the disease, in addition to which she conducted a follow-up on the effect of surgical techniques on the quality of life of 1,065 patients as well as the cost of care.
According to the findings, patients who had undergone a mastectomy had the highest number of symptoms detrimental to their quality of life. They also reported the most postoperative symptoms, including pain, fatigue and sleep disturbances.
Corrective surgery improves the quality of life
When a breast cancer tumour is operated on, the technique is chosen on the basis of, among other factors, the size of the tumour and the breast, their mutual proportions as well as the patient’s overall health and their wishes. The goal of modern care is to preserve the breast if possible.
If only a part of the patient's breast is resected, the remaining breast tissue can be shaped by utilising methods of plastic surgery. This way, the natural shape of the breast can be preserved. According to Rautalin’s research, the quality of life of patients operated on using such oncoplastic techniques improved the fastest, resulting in the best perceived body image among all study subjects.
The study also demonstrated that, after the removal and reconstruction of the breast in reconstructive surgery, it could take as long as two years for the quality of life of patients to recover.
“In other words, patients have to go through a long process. However, reconstructive surgery is worth it, since physical and sexual functioning improved the most in reconstruction patients,” Rautalin says.
Financial difficulties worsen the quality of life
Breast cancer is the most commonly diagnosed cancer in the world, with approximately 5,000 women developing it every year in Finland. The cost of care for patients in Finland mainly consists of fees for outpatient clinic visits and hospital stays, but society covers the overall costs of surgeries. According to Rautalin, the cost of care for society cannot dictate when or how reconstructive breast surgeries are carried out.
“The quality of life study indicated that financial difficulties worsen the patient’s quality of life. For some patients, outpatient clinic visit and hospital fees are a substantial expense. In fact, patients should be supported in covering these expenses. Pain, fatigue and sleep disturbances are also important factors where support is needed, as these symptoms occur to a certain degree in all patient groups. ”
“Our healthcare system has to take care of everyone, regardless of the cost of care. In terms of quality of life, it’s important to help patients restore their body image if they so wish. This is of great importance to both individuals and society, as the wellbeing of breast cancer patients is reflected throughout their social environment, in family relationships and even in coping at work.”
MD Mervi Rautalin will defend her doctoral thesis entitled ‘Surgical treatment of breast cancer and patient reported outcomes – Special emphasis on health-related quality of life and the cost of care’ on Friday, 9 December 2022 at 12.00 at the Faculty of Medicine, University of Helsinki. The public examination will take place in room U3032 of the University’s Main Building (Unioninkatu 34). Kerstin Sandelin from Karolinska Institutet will serve as the opponent and Professor Virve Koljonen as the custos.
The doctoral thesis is also available in electronic form through the Helda repository.