Wysocki, W.M., Mitus, J., Komorowski, A.L., & Karolewski, K. (2012). Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: A randomized clinical trial. Acta Chirurgica Belgica, 112, 111–115.

To evaluate the impact of information, provided preoperatively, on the anxiety and knowledge of women undergoing mastectomy for breast cancer; to assess the specific impact of additional, structured preoperative information (delivered by means of educational/informational video) on perioperative anxiety and treatment- and disease-related knowledge in women undergoing mastectomy for breast cancer

Routine information was delivered to both arms of the study. Information was not standardized and included the typical conversation with the attending surgeon, surgical informed consent, and practical information from nurses. The treatment arm provided additional information delivered preoperatively via video; the information was recorded by a breast cancer survivor. Information in the video was obtained from the National Cancer Institute’s website. All patients were prospectively followed for one month (further follow-up was performed according to local treatment protocols) at 24–36 hours, 7 days, and 30 days postoperatively.

• The study reported on a sample of 58 female patients.
• Mean patient age was 60 years in the intervention group and 55 years in the control group.
• Patients had a diagnosis of breast cancer needing mastectomy, with cytologically or histologically proven invasive breast cancer. More than 80% in both arms had IIA and IIB stage disease, and 76% were diagnosed with ductal carcinoma.
• Women were older than 18 years of age and had the physical and psychological ability to use a visual analog scale and to complete requested questionnaires.
• Women were excluded from the study if they were admitted for breast-conserving therapy, neoadjuvant treatment for breast cancer, disseminated breast cancer, vision and/or hearing impairment, previous treatment for other malignancies, medical education, and other factors (geographical and familial) that would interfere with the protocol requirements.

• Inpatient
• Department of Surgical Oncology, Maria Sklodowska-Curie Memorial Institute of Oncology, Krakow, Poland

• Phase of care: active treatment
• Clinical applications: late effects and survivorship

Open-labeled, randomized controlled trial

• To measure anxiety: A visual analog scale (VAS) for anxiety was validated and shown to be the clinical equivalent of the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI).  
• To measure level of knowledge: Investigators used a VAS (a subjective measure) as well as a self-administered questionnaire (an objective measure) containing specific questions about breast cancer treatment and familial risk.

• Authors noted no significant differences in anxiety levels between the intervention and control arms over all four time points.
• Authors noted no significant differences in subjective or objective knowledge between the intervention and control arms over all four time points.
• The number of patients confirming the association of the participant’s disease with an elevated risk for breast cancer in children or close blood relatives increased in the intervention arm from 40% preoperatively to 70% postoperatively.

Patients who participated in the study showed no evident or significant improvement in perioperative anxiety or treatment- and disease-related knowledge, with the exception of knowledge concerning available primary treatment modalities.

• The study had a small sample size, with fewer than than 100 participants.
• The outcomes of this study may result from having no a priori sample size estimation or power analysis. Interpreting results was difficult.

Patient education, as well as emotional support, should always be important preoperatively and must continue postoperatively.