Breast Conserving Therapy and Quality of Life in Thai Females: a Mixed Methods Study

  • Peerawong, Thanarpan (Department of Radiology, Faculty of Medicine, Prince of Songkla University) ;
  • Phenwan, Tharin (Walailak University School of Medicine) ;
  • Supanitwatthana, Sojirat (Faculty of Liberal Arts, Rajamangala University of Technology Suvarnabhumi) ;
  • Mahattanobon, Somrit (Department of Surgery, Faculty of Medicine, Prince of Songkla University) ;
  • Kongkamol, Chanon (Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine, Prince of Songkla University)
  • Published : 2016.06.01


Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.


Supported by : Songkla University


  1. Acil H, Cavdar I (2014). Comparison of quality of life of Turkish breast cancer patients receiving breast conserving surgery or modified radical mastectomy. Asian Pac J Cancer Prev, 15, 5377-81.
  2. Al-Naggar RA, Nagi NM, Ali MM, et al (2011). Quality of life among breast cancer patients in Yemen. Asian Pac J Cancer Prev, 12, 2335-41.
  3. Boquiren VM, Esplen MJ, Wong J, et al (2013). Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psychooncol.
  4. Bredin M (1999). Mastectomy, body image and therapeutic massage: a qualitative study of women's experience. J Adv Nurs, 29, 1113-20.
  5. Chang O, Choi EK, Kim IR, et al (2014). Association between socioeconomic status and altered appearance distress, body image, and quality of life among breast cancer patients. Asian Pac J Cancer Prev, 15, 8607-12.
  6. Collins KK, Liu Y, Schootman M, et al (2011). Effects of breast cancer surgery and surgical side effects on body image over time. Breast Cancer Res Treat, 126, 167-76.
  7. Early Breast Cancer Trialists' Collaborative G, Darby S, McGale P, et al (2011). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet, 378, 1707-16.
  8. Exner R, Krois W, Mittlbock M, et al (2012). Objectively measured breast symmetry has no influence on quality of life in breast cancer patients. Eur J Surg Oncol, 38, 130-6.
  9. Falk Dahl CA, Reinertsen KV, Nesvold IL, et al (2010). A study of body image in long-term breast cancer survivors. Cancer, 116, 3549-57.
  10. Figueiredo MI, Cullen J, Hwang YT, et al (2004). Breast cancer treatment in older women: does getting what you want improve your long-term body image and mental health? J Clin Oncol, 22, 4002-9.
  11. He ZY, Tong Q, Wu SG, et al (2012). A comparison of quality of life and satisfaction of women with early-stage breast cancer treated with breast conserving therapy vs. mastectomy in southern China. Support Care Cancer, 20, 2441-9.
  12. Hofstede GH, Hofstede GJ, Minkov M (2010). Cultures and organizations: software of the mind: intercultural cooperation and its importance for survival, New York, McGraw-Hill.
  13. Hopwood P, Fletcher I, Lee A, et al (2001). A body image scale for use with cancer patients. Eur J Cancer, 37, 189-97.
  14. Hopwood P, Haviland J, Mills J, et al (2007). The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast, 16, 241-51.
  15. Huang CC, Lien HH, Tu SH, et al (2010). Quality of life in Taiwanese breast cancer survivors with breast-conserving therapy. J Formos Med Assoc, 109, 493-502.
  16. Jankowski GS, Diedrichs PC, Williamson H, et al (2016). Looking age-appropriate while growing old gracefully: A qualitative study of ageing and body image among older adults. J Health Psychol, 21, 550-61.
  17. Krishnan L, Stanton AL, Collins CA, et al (2001). Form or function? Part 2. Objective cosmetic and functional correlates of quality of life in women treated with breastconserving surgical procedures and radiotherapy. Cancer, 91, 2282-7.<2282::AID-CNCR1259>3.0.CO;2-0
  18. Lamarche L, Kerr G, Faulkner G, et al (2012). A qualitative examination of body image threats using Social Self-Preservation Theory. Body Image, 9, 145-54.
  19. Lehmann V, Hagedoorn M, Tuinman MA (2015). Body image in cancer survivors: a systematic review of case-control studies. J Cancer Surviv, 9, 339-48.
  20. Miller SJ, Schnur JB, Weinberger-Litman SL, et al (2014). The relationship between body image, age, and distress in women facing breast cancer surgery. Palliat Support Care, 12, 363-7.
  21. Munshi A, Dutta D, Kakkar S, et al (2010). Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: a prospective study. Radiother Oncol, 97, 288-93.
  22. Ohsumi S, Shimozuma K, Morita S, et al (2009). Factors associated with health-related quality-of-life in breast cancer survivors: influence of the type of surgery. Jpn J Clin Oncol, 39, 491-6.
  23. Peerawong T, Mahattanobon S, Jiratrachu R, et al (2015). Cosmetic outcomes and quality of life in Thai women post breast conserving therapy for breast cancer. Asian Pac J Cancer Prev, 16, 4685-90.
  24. Przezdziecki A, Sherman KA, Baillie A, et al (2013). My changed body: breast cancer, body image, distress and selfcompassion. Psychooncol, 22, 1872-9.
  25. Shen FR, Liu M, Zhang X, et al (2012). Health-related quality of life among breast cancer patients and its influencing factor in a Chinese population. Asian Pac J Cancer Prev, 13, 3747-50.
  26. Shoma AM, Mohamed MH, Nouman N, et al (2009). Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients. World J Surg Oncol, 7, 66.
  27. Sun Y, Kim SW, Heo CY, et al (2014). Comparison of quality of life based on surgical technique in patients with breast cancer. Jpn J Clin Oncol, 44, 22-7.
  28. Takei H, Ohsumi S, Shimozuma K, et al (2012). Health-related quality of life, psychological distress, and adverse events in postmenopausal women with breast cancer who receive tamoxifen, exemestane, or anastrozole as adjuvant endocrine therapy: national surgical adjuvant study of breast cancer 04 (N-SAS BC 04). Breast Cancer Res Treat, 133, 227-36.
  29. Veronesi U, Cascinelli N, Mariani L, et al (2002). Twentyyear follow-up of a randomized study comparing breastconserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 347, 1227-32.
  30. Waljee JF, Hu ES, Ubel PA, et al (2008). Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol, 26, 3331-7.