유방재건술 시행 여부에 따른 유방암 환자의 심리적 차이와 하위집단 분석: 고위험군 규명을 중심으로

초록

Objectives: Breast cancer surgery can significantly impact psychological well-being due to changes in body image and concerns about femininity. This study aimed to explore psychological differences between patients who underwent breast reconstruction after surgery and those who did not, identifying subgroups in need of psychological support. Methods: The study included 194 patients who had breast cancer resection at Kyungpook National University Hospital and its Breast Cancer Center from July 2010 to December 2012. Psychological assessments were conducted within a week post-surgery using the Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), and Body Image Scale (BIS). We applied analysis of covariance to adjust for age and performed K-means cluster analysis. Results: The non-reconstruction group (n=126) exhibited significantly higher HADS scores (14.92±6.65 vs. 11.82±5.92, p=0.002), anxiety (7.37±3.64 vs. 5.94±3.24, p=0.008), and depression (7.46±3.56 vs. 5.91±3.44, p=0.007), along with lower self-esteem (27.07±4.83 vs. 28.98±4.25, p=0.016) compared to the reconstruction group (n=68). Cluster analysis identified two subgroups within the non-reconstruction group: one (Cluster 3, n=35, 27.8%) with high BIS scores, anxiety, and low self-esteem, and another (Cluster 4, n=65, 51.6%) with better psychological health. Importantly, BIS emerged as a significant factor for differentiating subgroups solely within the non-reconstruction group. Conclusions: Patients who did not undergo breast reconstruction surgery generally demonstrated negative psychological outcomes. However, the cluster analysis revealed two distinctly different subgroups within this population. Approximately one-quarter (27.8%, n=35) displayed high levels of anxiety and depression, low self-esteem, and severe body image concerns, while about half (51.6%, n=65) maintained good psychological health. This underscores the need to identify patients requiring special clinical attention, even within the same treatment group. Body image assessment may be a valuable evaluation tool specifically for patients who did not undergo breast reconstruction surgery.

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