What to ask patients post (after) mastectomy for ductal carcinoma?

Key Assessment Points for Post-Mastectomy Ductal Carcinoma Patients

Post-mastectomy patients with ductal carcinoma require systematic follow-up focused on detecting recurrence, managing complications, and addressing quality of life issues. 1

Physical Assessment

• Pain and discomfort:

  • Evaluate for post-mastectomy pain syndrome (PMPS), a chronic neuropathic pain condition 2
  • Assess surgical site healing and scar formation
  • Check for painful scarring that may limit arm/shoulder mobility 1

• Lymphedema:

  • Measure arm circumference compared to unaffected side
  • Assess for swelling, heaviness, and discomfort in the affected arm
  • Document severity and functional limitations 1

• Chest wall examination:

  • Thoroughly examine the mastectomy site and surrounding tissue for:
    • Nodules or masses
    • Skin changes (redness, thickening)
    • Surgical scar abnormalities
  • Even with mastectomy's high cure rate (98-99%), local recurrence is possible 1, 3

Psychological Assessment

• Body image concerns:

  • Assess patient's perception of cosmetic outcome
  • Discuss feelings about physical appearance and self-esteem
  • Note that mastectomy with immediate reconstruction patients may report more body image issues than expected 4

• Emotional well-being:

  • Screen for anxiety and depression using validated tools (e.g., Hospital Anxiety and Depression Scale)
  • Assess for fatigue, which significantly impacts quality of life 1
  • Evaluate sexual adaptation and feelings of desirability 1

Functional Assessment

• Arm and shoulder function:

  • Range of motion in the affected shoulder
  • Strength in the affected arm
  • Ability to perform activities of daily living

• Quality of life measures:

  • Use visual analog scales to assess overall well-being 1
  • Evaluate impact on daily activities and functional competence

Surveillance for Recurrence

• Local recurrence risk:

  • Though rare after mastectomy (1-2%), recurrence can occur 1, 3
  • Examine chest wall thoroughly at each visit
  • Educate patient on self-examination of chest wall

• Contralateral breast assessment:

  • Clinical breast examination
  • Appropriate imaging based on risk factors and guidelines

Treatment Satisfaction and Future Planning

• Satisfaction with surgical outcome:

  • Assess contentment with the decision for mastectomy versus breast conservation
  • Discuss reconstruction options if not already performed

• Adjuvant therapy discussion:

  • Review compliance with any ongoing treatments
  • Address side effects of treatments
  • Discuss the role of tamoxifen if appropriate 1

Common Pitfalls to Avoid

• Underestimating psychological impact: Body image and emotional concerns may persist years after surgery 4
• Overlooking chest wall recurrence: Despite mastectomy's high cure rate, vigilant monitoring is necessary 3
• Neglecting functional limitations: Shoulder mobility and arm function issues can significantly impact quality of life
• Minimizing pain concerns: PMPS affects many women and requires specific assessment and management 2

By systematically addressing these key areas during follow-up visits, clinicians can provide comprehensive care that addresses both the physical and psychological needs of post-mastectomy ductal carcinoma patients.