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Title: Women's perspectives of radiotherapy combined with deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis musculocutaneous (TRAM) free flap breast reconstructions post mastectomy for breast cancer
Author: Harmer, Victoria Margaret Lucas
ISNI:       0000 0004 5372 0431
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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Abstract:
Aim: To investigate women’s perspectives of radiotherapy combined with deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis musculocutaneous (TRAM) free flap breast reconstructions post mastectomy for breast cancer. Background: Breast cancer can be treated by a number of modalities. Two of these are surgery and radiotherapy. If a mastectomy is recommended an immediate breast reconstruction may also be offered. There are a number of different reconstructive techniques; one uses tissue from the abdomen, and another uses tissue and muscle. In some cases radiotherapy may be recommended and delivered post-operatively as an adjuvant. There is confusion in the literature whether radiotherapy has a detrimental effect on these autologous (tissue-only) reconstructions, and there is limited research in this arena from the patient’s perspective. Method: Three focus groups were held in London in 2013. The aim of these groups was to explore the experiences of women who had received this combination of treatment, and to identify their thoughts on whether post-operative radiotherapy impacted their tissue-only immediate breast reconstructions. Data from these focus groups were transcribed and analysed using framework analysis. Results: Six themes emerged from the data; Being changed, Control, Coping strategies, Information, Normalisation and Trust/faith in healthcare professionals. The women did not appear to be worried about the combination of treatment or any effects the radiotherapy had on their immediate autologous breast reconstructions; furthermore, they would recommend this option to others in the same situation. The women discussed their experience of breast cancer and how this had affected them. The data illustrated that breast cancer and treatment reverberated through every aspect of the women’s life; their self-identity, daily routines and experiences with friends and family. In context of the enormity of the breast cancer experience, the combination of treatment with immediate autologous reconstruction followed by radiotherapy appeared well tolerated and not a notable issue for the participants. Although longer-term issues are not known, these women reported that other aspects of their treatment had been challenging, for example chemotherapy, but when reflecting on their whole experience these did not seem too great in hindsight. Conclusions: This is the first study to report qualitative data on this specific combination of treatment. The findings of this research are that the participants did not voice concerns regarding the delivery of post-operative radiotherapy on their DIEP or TRAM flap immediate breast reconstructions. Understanding the thoughts and experiences of these women will furnish healthcare professionals with information, assist them when recommending treatment for women within this setting, and give confidence and encouragement when suggesting this combination of treatment. It is hoped that this will translate to a better patient experience and enable clinicians to target and assist with specific needs in a holistic manner.
Supervisor: Norton, Christine Susan ; Grocott, Patricia Rosalind ; Barley, Elizabeth Alexandra Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.679755  DOI: Not available
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