Patients with breast cancer who receive mastectomies and are discharged the same day report similar levels of satisfaction to those who are admitted, but more research is needed, explained an expert.
Patients with breast cancer who receive a mastectomy and are discharged from the hospital on the same day displayed similar levels of satisfaction with their physical health, psychosocial wellbeing and care team compared to those who stay overnight at the hospital, according to findings from a recent study.
These results, which were presented at the 2022 San Antonio Breast Cancer Symposium, suggest that patients who receive mastectomies are able to tolerate same-day discharge well, but further research is still needed, lead study author Dr. Sudheer Vemuru, a PGY-4 surgery resident at the University of Colorado School of Medicine, Aurora, said in an interview with CURE®.
“In the 1990s, a lot of patients were scared to go home after mastectomy; they felt like they weren't ready to begin the recovery process at home,” he said. “They felt like the ‘in-the-door, out-the-door’ process was rushed.”
In fact, Vemuru said the process was so common, that a New York Times article reported on the issue and coined the term “drive-by mastectomies.”
After the article was published, there was more push back and in 1999, the New York Senate passed the Women's Health and Cancer Rights Act to ban this practice.
“Now, fast forward 20 years or so,” Vemuru said. “A lot has changed in medicine, a lot has changed in what we know about the wound healing process, the recovery process after surgery … we've moved a lot of the patient education and counseling to the period prior to surgery.”
While same-day discharge was originally only offered to patients who opted not to undergo reconstruction, this group has recently expanded to include patients who were had implant-based reconstruction or having tissue expanders placed, Vemuru explained.
“Those patients may benefit from recovery at home where things are familiar, where they can get better sleep, where they're managed…(by) people who know the patient better. That sense of comfort and that sense of safety (has) improved over the past few years.
Then, the COVID-19 pandemic accelerated this trend.
“The pandemic expedited our initiative to expand same-day discharge after mastectomy to the more general population just because hospital beds were (in) short (supply),” Vemuru explained.
“We didn't want to expose patients…to potentially contract COVID within the hospital during that early period,” he continued. “At our institution, we noticed that a larger quantity of patients (was) going home and felt comfortable going home.”
Vemuru and his colleagues constructed a study to measure patients’ wellbeing following surgery.
The study involved 59 patients with breast cancer who had received mastectomies between June 2019 and June 2022 and who reported their perceptions of their quality of life using the validated BREAST-Q questionnaire before and after surgery.
Of the 59 patients who participated, 21 were discharged the same day of mastectomy and 38 were admitted to the hospital. The mean satisfaction score of the surgeon, from a scale of 0-100, for patients who were discharged the same day was 88.1 while the score for patients who were admitted was 90.
The mean satisfaction score with the medical team, from a scale of 0-100, for patients who were discharged the same day was 94.7, while the score for patients who were admitted was 94.2.
The patients who were discharged the same day reported a mean decrease of 11.7 points in their psychological well-being score while patients who were admitted reported a decrease of 5.8 points.
“This is an ongoing study. We don't necessarily have the volume of patients within our database to definitively say one way or the other, but the trends that we see in our early data collection are promising,” he explained. Of note, Vemuru and his mentor, Dr. Sarah Tevis, an assistant professor of surgery at the University of Colorado School of Medicine, Aurora, plan on continuing follow-up for patients enrolled in the study for another five years.
He also stressed that this is a new topic that needs further research.
Vemuru explained that he hopes that research can be done on more diverse patient populations in different areas of the country and in a prospective manner (following patients from when they receive treatment).
The results of this study, Vemuru explained, indicate a need to move towards a more patient-focused approach for post-surgery care.
He stressed that a patient must speak with their surgeon before making the decision and consider their health and how far they live from a hospital, so they can easily get care if a complication were to occur.
“I think it really depends on the patient's comfort level with what their home situation is and how comfortable the physician is with their with their level of health prior to surgery,” Vemuru said.
“Our goal in our breast (cancer) center is to emphasize patient centeredness and… shared decision making,” Vemuru concluded. “If a patient is interested in going home on the day of their surgery, that's something that they should discuss with their surgeon (and) with their family to make sure that they have all of the support tools and mechanisms in place.”
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