Researchers looked at additional support that could help women discuss their goals and priorities for breast reconstruction surgery with their surgeon. This could empower women and inform their decision so that their reconstruction can meet their expectations.

A doctor in consultation with an older female patient in a wheelchair, and her female caregiver

Researchers funded by Breast Cancer Now have developed a new way of supporting women who are deciding whether to have breast reconstruction or not.

This new support tool, called PEGASUS, helped reduce levels of anxiety, depression and regret for women who’ve had a mastectomy as part of their breast cancer treatment.

Now, the tool is available as a free resource to trained health professionals, so that it can reach those who need it the most.

A tool for support

Making decisions about breast reconstruction can be a stressful and difficult time for women during their breast cancer treatment. Many women feel that the results of the reconstruction do not meet their expectations, which can lead to distress and a low quality of life.

Professor Dianna Harcourt, Co-Director of the Centre for Appearance research at the University of West of England and her team developed a new way to help women when they are considering and discussing their expectations and goals for the surgery.

The support tool, called PEGASUS (which stands for Patients’ Expectations and Goals: Assisting Shared Understanding of Surgery) involves working with a specially trained nurse or psychologist.

They work with the patient to complete a questionnaire which discusses their expectations and goals and helps patients clarify their thoughts and expectations about breast reconstruction. This questionnaire can then help better inform their surgeon when they meet to discuss their surgery.

It also helps women to think about and define  their priorities for surgery as well as their long-term goals, so they are ready to discuss their expectations and goals for breast reconstruction with their surgeon.

Testing the PEGASUS approach

The tool was tested in a clinical trial funded by Breast Cancer Now, where patients were recruited across NHS hospitals in the South of England and Wales.

In this clinical trial, 86 women received the usual care that patients receive with the NHS whereas 52 women were given access to PEGASUS support.

Six months after reconstructive surgery, the researchers found that women who had received support experienced lower levels of distress and remorse following their decision than those who did not receive the support.

Professor Diana Harcourt, Co-Director of the Centre for Appearance Research at the University of the West of England, Bristol, who led the PEGASUS trial explained: ‘Our support method allowed women to have a more positive experience throughout their reconstructive surgery, and health professionals have also seen more positive results.’

In comparison, the group who received usual care said that they felt overwhelmed by the amount of information and that the surgery consultation was difficult to process. Women in this group felt that they were unable to make an informed decision.

However, a year after surgery there was no difference between the two groups. This highlights that whilst additional support like PEGASUS may not have long-lasting effects in terms of decision regret, it can provide help and comfort during a difficult and stressful decision-making time.

Effects on daily life

After twelve months, women who received PEGASUS reported an improved quality of life and felt more able to take part in their usual daily activities than those who did not receive PEGASUS.

They also felt that they had better relationships with their friends and family, that there was more stability in their life and felt that they were enjoying life more.

Dr Simon Vincent, Director of Research, Support and Influencing at Breast Cancer Now, added: ‘Different women will have different needs when it comes to reconstruction, some may prioritise surgery that doesn’t impact on an active lifestyle, whilst others may be looking for an aesthetic goal.

Each of these priorities needs to be considered by a surgeon ahead of surgery taking place so that women and their surgeons are on the same page as to what a ‘successful’ surgery will be.

We hope this research is a step towards shared decision making between women undergoing reconstructive surgery and healthcare professionals.’

 

The research was published in the European Journal of Cancer Care.