Tailored Intervention Aids Distress, Recovery After Breast-Conserving Surgery

Out of 75 participants, 29 provided detailed insights on what they experienced post surgery.

Psychosocial assessments and tailored interventions to support recovery in the outpatient setting following breast-conserving surgery for patients with early-stage breast cancer is critical to improving patient outcomes, according to Jennifer Ross Majumdar, PhD, CRNA.¹

A qualitative study of open-ended patient responses, presented at the 50th Annual ONS Congress, underscored the need to address physical and psychological needs in the outpatient setting in order to improve outcomes.

“We really need to be looking at psychosocial assessments that can be integrated into routine postoperative care,” Majumdar, nurse scientist at Memorial Sloan Kettering Cancer Center in New York, New York, said during a presentation at the Congress.

“…We really need to be looking at how we are assessing that, particularly in the outpatient setting. We also need to develop some tailored interventions to support women in these outpatient settings while theyre at home recovering from surgery and oncology nursing practice really needs to incorporate strategies to address both the physical as well as these emotional needs at this important time period.”

Assessment Needs

“One in 8 American women will experience breast cancer in their lifetime, and the majority are diagnosed at an early stage when surgery remains the primary treatment,” Majumdar noted, adding that breast-conserving surgery is the most common type of surgery conducted in tandem with radiation therapy.

Many times, the turnaround time from diagnosis to surgery is fast, adding to the existing anxiety from diagnosis, as well as stress while waiting for pathology results as part of the surgical process. Following surgery, physical symptoms often include pain and postoperative nausea and vomiting. Although known symptoms, limited research on distress symptom management and a lack of tailored interventions remain.

“We really need more evidence to guide oncology nursing practice,” Majumdar said.

Therefore, the study investigators aimed to have an in-depth understanding of patients distress and coping mechanisms by analyzing open-ended responses in order to identify patterns in post-operative experiences following breast-conserving surgery.

In particular, they focused on physical symptoms (pain and nausea), psychological symptoms (distress and emotional impact), and coping strategies (patient-reported methods to manage symptoms).

As part of a repeat-methods study² on symptom management in women with early-stage breast cancer, the qualitative study focused on open-ended, free-response data.

The study included 75 women with early-stage breast cancer following surgery day 1 and day 14, with data collected from August 15 to October 15, 2020.

Concerns and Coping

Among the 75 participants, 29 provided detailed responses, with common themes of stress and anxiety including family concerns, fears of cancer recurrence, pain and soreness, and psychological impact of COVID-19. Meanwhile, postoperative issues and other physical concerns were the unexpected physical symptoms and challenges managing surgical aftercare, as well as limitation in activity, sleep disturbances, and fatigue.

“The other thing I wanted to highlight was that [patients] also really wanted to share the things that worked well for them [in the open-ended questions], and one of the big things was the support that they had from their care team. That was a big piece that really helped them feel better,” Majumdar noted.

Additional coping strategies reported were pain management adaptation, including how to position pillows, ice packs, and medication adjustments; wellness practices, including mediation and deep breathing; and gentle exercise, including walking and stretching.

“They wished [these coping strategies] had been shared with them, and they wanted to share with other patients as well,” she added.

With these strategies, patients in the study reported gradual improvements in sleep quality, pain levels, and anxiety and emotional distress.

“The reason why this is important is the majority of these patients dont see their surgeon until that 2-week period, and thats when, at that time, theyve already gotten the results of those additional biopsies, so they understand the course of their treatment,” Majumdar explained. “But by that time, theyre feeling better, and so that doesnt mean that they didnt have a very severe symptom experience during that time period, But at that point, especially when theyre meeting with their surgeon, they dont want to bring it up, and they dont want to mention it.”

Future Directions

As a result of the findings, Majumdar noted that an integrated approach to physical and psychological needs, as well as structured support systems in the outpatient setting are crucial to enhance outpatient recovery. With this, oncology nurses and advanced practice providers can help to address distress and pain together.

“So the future research directions are really to look at the long-term effects of how effective some of these coping strategies are, to look at the role of psychosocial care and home recovery, and to give some interventions and to see how well they are able to help these patients,” Majumdar concluded. “And really to identify the best practices for outpatient distress management, particularly as surgery continues to go more and more in that direction.”

Reference:

1. Ross Majumdar J, Gilliand J, Barton-Burke M, Jairath N. Navigating distress and recovery: A qualitative exploration of pain, nausea, and coping strategies in women undergoing breast-conserving surgery. Presented at: 50th Annual ONS Congress; April 9-13, 2025; Denver, CO.

2. Majumdar JR, Goodman P, Barton-Burke M, Gilliland J, Jairath N. Distress, pain, and nausea on postoperative days 1 and 14 in women recovering from breast-conserving surgery: A repeated-measures study. Oncol Nurs Forum. 2024 Jun 14;51(4):381-390. doi:10.1188/24.ONF.381-390.