Where do breast cancer patients after curative-intent surgery stand in their Health-related Quality of Life (Hr-QoL) outcomes compared with health institution-based normal clients? A comparative cross-sectional study

Abstract

Background

Breast cancer reduces quality of life. Hr-QoL after all types of surgeries in general and after elective breast surgeries like mastectomy in particular is, however an under-researched area worldwide. This gap is conspicuously felt and seen especially in developing countries like Ethiopia. The main objective of this study was to assess the Hr-QoL outcomes of breast cancer cases after curative-intent surgery in comparison with health institution-based normal individuals.

Methods and patients

A comparative cross-sectional study using SF-36 was conducted to compare Hr-QoL outcomes of representatively sampled 366 post-mastectomy women and health institution-based women as controls. The collected data were analyzed using SPSS windows version 21. The mean ranks of the Hr-QoL outcomes on a 0 to 100 scale were compared between the two groups using Mann-Whitney U test at p-value ≤ 0.05 (two-sided).

Results

Three hundred sixty-six participants (366), 183 cases and 183 controls were included in the analysis. Post-mastectomy cases had a median Physical Functioning (PF) of 70.0; Role-Physical (RP) of 75.0; Bodily Pain (BP) of 44.0; General Health (GH) of 35.0; Vitality (VT) of 40.0; Social Functioning (SF) of 50.0; Role-Emotional (RE) of 33.3; and Mental Health (MH) of 44.0. The respective values for the control group were: 75.0; 75.0; 54.0; 50.0; 55.0; 62.5; 66.7; and 64.0. PF and RP showed no statistically significant difference between the two groups. On the other hand, BP, GH, VT, SF, RE and MH were significantly lower in the post-mastectomy group.

Conclusion

Quality of life of breast cancer patients after a curative-intent mastectomy was found to be lower. They had significantly lower scores in scales measuring mental health and those measuring both physical and mental health. Of the three scales assessing physical health, bodily pain was significantly lower.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-025-04233-w.

Background

Breast cancer is one of the leading malignancies worldwide. A global data showed that millions of new cases and hundreds of thousands of deaths from breast cancer were reported in 2020. It disproportionately affects females. The global burden of the disease is found concentrated in the older age group [1, 2]. Though the incidence of the disease is relatively lower in developing regions of the globe like the Sub-Saharan Africa, the mortality rate is disproportionately high making the disease a major health challenge and burden in the region [3].

An effective breast cancer treatment follows a multidisciplinary and multimodality approach [4–6]. Breast surgery remains to be at the center of therapy for early-stage disease [6, 7]. It is a commonly practiced procedure worldwide [8]. With less clear report of the intent of use, it is also found to be the most commonly chosen treatment modality across Africa [9]. The management of such patients with an intent of cure is given for early and local-regional disease [4–6]. On the other hand, the main goals of treatment for an advanced and metastatic breast cancer include: relieving symptoms, improving survival, preventing or delaying progression of the disease and maintaining or improving quality of life [10]. Surgery has limited or no role in improving quality of life among women having metastatic disease [11].

With improvements and advances in early diagnosis and treatment services, a marked reduction in breast cancer mortality has been achieved in resource-rich settings and nations [12–15]. In nations where breast cancer screening and management is so scarce and under-developed, late-stage presentation and shorter survival rates are common [16–22]. Generally, the reality currently witnessed worldwide is that the proportion of breast cancer survivors is steadily expanding. This success is, however associated with a challenge to the provider to face and deal with multiple late and long-term side effects and complications from treatments with a significant negative impact on physical, mental and social wellbeing [23–26].

Breast cancer treatments may develop devastating complications like lymphedema, chronic pain and arm and shoulder impairments [24, 27]. Twenty-five to 60% of patients develop a chronic pain after breast cancer surgery [28]. Studies showed that the negative impact of breast cancer on mental health outcomes is huge [29]. Low satisfaction with their body image and appearance is also an important problem among survivors after surgery [30, 31]. Such long-term complications and side effects of treatments hugely lower quality of life of breast cancer survivors [24, 32, 33].

With the excellent survival rates achieved for patients having several cancer types including those with breast cancer [34], a fundamental change in approach from the traditional treatment outcome measures such as mortality and morbidity to maintaining improved quality of life after surgery has received a sizeable attention in the management of surgical patients. This is a fundamental shift to a long-term wellness and health. However, Hr-QoL after all types of surgeries in general and after elective surgeries like mastectomy in particular is an under-researched area worldwide [35–37]. This gap is conspicuously felt and seen especially in developing countries like Ethiopia. Few studies from Ethiopia showed that the social and psychological support was poor and the quality of life was reported to be low [38, 39]. These studies, however assessed the quality of life of cases treated with and without curative intent mixed. They also did not compare the quality of life of breast cancer patients with normal individuals. The main objective of this study was to assess the Hr-QoL outcomes of breast cancer cases after surgery of curative intent in comparison with health institution-based normal individuals.

Methods and patients

Study design, period and area

A comparative cross-sectional study was carried out from January, 2024 to December, 2024 in Tikur Anbessa Specialized Hospital (TASH) and Churchill Health Center (CHC) located in Addis Ababa, the capital city of Ethiopia. The hospital was established in 1964 and it is the largest academic and clinical center in the country. It works under the administration of College of Health Sciences of Addis Ababa University. CHC is a center where the staff of the college give a one-stop breast care.

Sample size calculation

The study had two groups: post-mastectomy cases and health institution based normal controls. To detect a 10-point difference in the means of the Hr-QoL outcomes on a 0 to 100 scale between two independent groups, previously published papers recommend sample sizes of 52 and 183 for the MH and RP scales of the Medical Outcomes Study 36-Item Short Form (SF-36), respectively [40]. The recommended sample sizes for the remaining six scales are between 52 and 183. The maximum recommended sample size, 183 was taken to each of the two groups in our study (n = 366).

Inclusion & exclusion criteria

The post-mastectomy (post-modified radical mastectomy, post-MRM) group included all consenting female adults (≥ 18 years of age) at least six months after mastectomy with a curative intent was done for their breast cancer. Those less than six months post-surgery were excluded to allow full recovery from their major surgery. The control group included clients with no known or diagnosed comorbidity or disease who visited CHC for breast screening services. Individuals with known or diagnosed comorbidity were excluded from the control group. Those who are under 18 years of age; declined to give a consent and/or failed to respond to two phone calls in two different attempts were excluded from both groups.

Sampling methods and data collection tools and procedures

Clinical charts and records of all post-mastectomy cases investigated and treated at TASH and CHC from Jan, 2021-Dec, 2024 were reviewed to ensure for meeting the inclusion criteria. A total of 244 post-mastectomy cases that met the inclusion criteria were identified; and the post-mastectomy group participants (n = 183) were randomly selected from these 244 cases by a lottery method. The controls were selected by systematic sampling method from clients who visited CHC for breast screening from Jan, 2023 to Dec, 2024 taking their order of visit and registration as a sampling frame.

A self-developed data abstracting form for the sociodemographic and clinical data and Medical Outcomes Study Questionnaire Short Form 36 (SF-36 tool) to measure the Hr-QoL outcomes were used (See Supplementary file 1). SF-36 has been developed, widely validated and published elsewhere. It is a generic Hr-QoL instrument with eight scales: PF, RP, BP, GH, VT, SF, RE and MH. It also contains a Reported Health Transition (RHT) item. It has been developed to be applicable across a broad range of interventions and populations. Its scales are scored in such a way that a higher score shows a better health status. A higher BP score, for example indicates freedom from pain. For interested readers, details of the tool are found published elsewhere [40–42].

The non-surgical treatment of the cases was largely left to the discretion of the oncologists that considered factors like the stage of the breast cancer which was classified based on the American Joint Committee on Cancer (AJCC) TNM (tumor, node, metastasis) staging system [43]. The data were collected by interviewer-administered questionnaire, phone calls and review of clinical records.

Data quality assurance and data collectors

Data collectors were surgical fellows and they were given a training on the main purpose of the study and the application of the questionnaire. The questionnaire has been prepared in a simplified manner that can be easily understood by the data collectors and participants. The whole process of the research was closely supervised by the principal investigator.

Statistical analysis

The collected data were entered, cleaned and analyzed using SPSS version 21. Measures of central tendency like mean and median and those of dispersion such as standard deviation (Sd) and interquartile range (IQR) were estimated and reported. Wilson score interval method was used to calculate the 95% confidence intervals of proportions. For the SF-36 scales were found to be not normally distributed, the mean ranks of the standardized scores (on a 0 to 100 scales) of the eight scales were estimated and compared between cases and controls using Mann-Witney U test at p-value ≤ 0.05.

Results

Sociodemographic and clinical data of participants

Three hundred sixty-six female participants (183 in each of the two study groups) were included in the analysis. The median age in years for the post-mastectomy group was estimated to be 45 (IQR: 15). The control group had a median age of 36 years (IQR: 15). The age difference was statistically significant (p < 0.001). 80% of the participants in the post-mastectomy group and more than 40% of the control had an educational level of college or above, respectively. More than half of breast cancer patients had stage III disease. Because the study was carried out on breast cancer cases for whom a curative-intent surgery was done, the number of stage IV patients in the study was zero. The sociodemographic and clinical data of the participants is summarized in Table 1.

Table 1.

Sociodemographic and clinical data of women by study group, Central Ethiopia, Jan 2021 – Dec 2024 (N = 366)

Variables	Post-mastectomy N (%; 95% CI)	Control N (%; 95% CI)
Educational status
No formal education	53 (29.0; 22.9-35.9)	24 (13.1; 09.0-18.8)
Primary school	40 (21.9; 16.5-28.4)	43 (23.5; 17.4-29.6)
Secondary school	56 (30.6; 24.4-37.6)	40 (21.9; 16.5-28.4)
College and above	34 (18.6; 13.6-24.8)	76 (41.5; 34.6-48.8)
Marital status
Single	29 (15.8; 11.3-21.8)	20 (10.9; 07.2-16.3)
Married	120 (65.6; 58.4-72.1)	128 (69.9; 62.9-76.1)
Divorced	21 (11.5; 07.6-16.9)	26 (14.2; 09.2-19.3)
Widowed	13 (07.1; 04.2-11.8)	09 (04.9; 02.6-09.1)
Occupation
Government	38 (20.8; 15.5-27.2)	87 (47.5; 40.4-54.8)
Private	30 (16.4; 11.7-22.4)	36 (19.7; 14.6-26.0)
Self-employed	64 (35.0; 28.4-42.1)	49 (26.8; 20.9-33.6)
Unemployed	51 (27.9; 21.4-34.4)	11 (06.0; 03.4-10.4)
Religion
Orthodox	78 (42.6; 35.7-49.9)	124 (67.8; 60.7-74.1)
Muslim	56 (30.6; 24.4-37.6)	32 (17.5; 12.7-23.6)
Protestant	38 (20.8; 15.5-27.2)	19 (10.4; 06.8-15.6)
Catholic	11 (06.0; 03.4-10.4)	08 (04.4; 02.2-08.4)
Stage of breast cancer
Stage 0	07 (03.8; 01.9-07.7)	Not applicable
Stage I	23 (12.6; 08.5-18.2)	Not applicable
Stage II	50 (27.3; 21.4-34.2)	Not applicable
Stage III	103 (56.3; 49.0-63.3)	Not applicable
Stage IV	0 (0.00; 0.00-0.00)	Not applicable

CI confidence interval

Health-related quality of life outcomes

For each of the eight SF-36 scales (on a 0 to 100 scale), measures of central tendency like mean and median and measures of dispersion such as Sd and IQR have been estimated and reported. The 25th percentile (1st quartile, Q1) and the 75th percentile (3rd quartile, Q3) were also determined. With a belief that it facilitates the smooth and easy flow and report of the results. we introduced at this early stage of the results section the table that consists of the different estimates of the eight SF-36 scales for the two study groups and the p-values from the Mann-Witney U test used for the scales were not normally distributed (Table 2).

Table 2.

Health-related quality of life outcomes of participants by study groups, central Ethiopia, Jan 2021 – Dec 2024 (N = 366)

Scale	Post-mastectomy				Control				P-value
	Mean (Sd)	Mean Rank	Q1, Q3	Median (IQR)	Mean (Sd)	Mean Rank	Q1, Q3	Median (IQR)
PF	69.2 (12.7)	173.4	65.0, 80.0	70.0 (15.0)	72.4 (11.1)	193.6	65.0, 80.0	75.0 (15.0)	0.064
RP	67.1 (17.3)	174.4	50.0, 75.0	75.0 (25.0)	72.3 (20.3)	192.6	50.0, 100	75 (50.0)	0.073
BP	46.0 (25.0)	162.7	21.0, 64.0	44.0 (43.0)	55.7 (24.6)	204.3	40.0, 74.0	54.0 (34.0)	< 0.001
GH	37.8 (22.8)	148.8	17.0, 57.0	35.0 (40.0)	53.9 (23.8)	218.2	30.0, 75.0	50.0 (45.0)	< 0.001
VT	44.0 (21.6)	147.7	25.0, 60.0	40.0 (35.0)	59.3 (18.3)	219.3	45.0, 70.0	55.0 (25.0)	< 0.001
SF	53.6 (21.0)	165.4	37.5, 75.0	50.0 (37.5)	60.7 (18.1)	201.6	50.0, 75.0	62.5 (25.0)	0.001
RE	49.7 (17.5)	143.3	33.3, 66.7	33.3 (33.4)	69.6 (23.8)	223.7	66.7, 100	66.7 (33.3)	< 0.001
MH	46.4 (13.4)	119.7	36.0, 56.0	44.0 (20.0)	64.0 (8.0)	247.3	56.0, 72.0	64.0 (16.0)	< 0.001

Sd standard deviation, Q1 first quartile, Q3 third quartile, IQR interquartile range, PF physical functioning, RP role-physical, BP bodily pain, GH general health, VT vitality, SF social functioning, RE role-emotional, MH mental health

Physical functioning, role physical and bodily pain

These three scales measure the different aspects of physical health. The post-mastectomy group had a median Physical Functioning of 70.0 (IQR: 15.0); Role-Physical of 75.0 (IQR: 25.0); and Bodily Pain of 44.0 (IQR: 43.0). The respective values for the control group were 75.0 (IQR: 15.0); 75.0 (IQR: 50.0); and 54.0 (IQR: 34.0). The minimum scores for the PF, RP and BP in the post-mastectomy group were 35.0, 25.0 and 10.0, respectively. The respective minimum values for the control group were 45.0, 50.0 and 10.0. On the other hand, the maximum scores for the PF, RP and BP in the post-mastectomy group were 90.0, 100.0 and 100.0, respectively. The respective maximum values for the control group were 95.0, 100.0 and 100.0. In the post- mastectomy group, Bodily Pain was the widely dispersed SF-scale followed by the Role-Physical. In the control group, however the most widely dispersed one among the three SF-36 scales was the Role-Physical followed by the Bodily Pain. The Physical Functioning, however was relatively compacted about the median in both groups (Fig. 1).

Fig. 1.

Boxplots of Physical Functioning, Role-Physical and Bodily Pain of study participants. Both groups had similar scores of Physical Functioning and Role-Physical. Bodily Pain, however was found to be statistically significantly lower in the post-modified radical mastectomy (post-MRM) group showing that they have a lower physical health status in terms of this scale

General health and vitality

General Health and Vitality are used to measure both physical and mental health. The post-mastectomy group had a median GH of 35.0 (IQR: 40.0) and VT of 40.0 (IQR: 35.0). The values for the control group were 50.0 (IQR: 45.0) and 55.0 (IQR: 25.0), respectively. The minimum and maximum GH scores were 10.0 and 82.0 in the post-mastectomy and 20.0 and 100.0 in the control group, respectively. The maximum VT score was 100.0 in both groups; but its minimum score was 5.0 and 30.0 in the post-mastectomy and control groups, respectively (Fig. 2).

Fig. 2.

Boxplots of General Health and Vitality of study participants. The post-modified radical mastectomy (post-MRM) group had statistically significantly lower standardized scores in these two SF-36 scales than the controls

Social functioning, role-emotional and mental health

Social Functioning, Role-Emotional and Mental Health are used to measure different aspects of mental health. The post-mastectomy group had a median Social Functioning of 50.0 (IQR: 37.5); Role-Emotional of 33.3 (IQR: 33.4); and Mental Health of 44.0 (IQR: 20.0). The respective values for the control group were 62.5 (IQR: 25.0); 66.7 (IQR: 33.3); and 64.0 (IQR: 16.0). The minimum scores for the SF, RE and MH in the post-mastectomy group were 25.0, 0.0 and 28.0, respectively. The minimum respective values for the control group were 37.5, 33.3 and 52.0. On the other hand, the maximum scores for the SF, RE and MH in the post-mastectomy group were 87.5, 100.0 and 72.0, respectively. Such respective maximum values for the control group were 100.0, 100.0 and 76.0 (Fig. 3).

Fig. 3.

Boxplots of Social Functioning, Role-Emotional, and Mental Health of study participants. The post-modified radical mastectomy (post-MRM) group had statistically significantly lower standardized scores in these three SF-36 scales than the controls

Reported health transition

Participants were asked to generally rate their health compared with how it was a year ago. 40% of participants with breast cancer (n = 73; 39.9%) reported that their health is somewhat worse than it was a year ago. Almost a quarter (n = 43; 23.5%) of them said it is about the same. A health status much worse than now than a year ago was reported by 32 (17.5%) of the post-mastectomy group. Those who reported ‘much better’ and ‘somewhat better’ current health status were 13 (7.1%) and 22 (12.0%), respectively. In the control group, nearly half (n = 86; 47.0%) of the participants reported that their current health status is about the same. Sixty-six (36.1%) of them reported a health status somewhat better than how it was one year ago. Thirty-one (16.9%) of the control had a somewhat worse health.

Comparison of SF-36 scales between the study groups

AS it has been shown in Table 2, the mean rank of the Physical Functioning of the post-mastectomy group was lower than that of the control. However, the difference had not been statistically significant, p = 0.064. No statistically significant difference in the mean ranks of the RP was found between the two groups, p = 0.073. The Bodily Pain had been statistically significantly higher in the post-mastectomy group, p < 0.001. The mean ranks of the GH and VT scales were statistically significantly lower in the post-mastectomy group, p < 0.001 and p < 0.001, respectively. The mean ranks of SF, RE and MH were statistically significantly lower in the post-mastectomy group, p = 0.001, p < 0.001 and p < 0.001, respectively.

Discussion

One hundred and eighty-three women participants to each of the two study groups, post-mastectomy (post-modified radical mastectomy = post-MRM) and controls were included in the final analysis of the current study. The cases were relatively older than the controls. In both groups, about two thirds of the participants were married. Thirty-four (18.6%) of women in the post-mastectomy group and 76 (41.5%) of those in the control group had an educational status of college and above. This significant difference in their level of education may be due to the fact that the controls came mainly from the capital city of the country where the facility giving breast cancer screening is found whereas the post-mastectomy group came from both the capital as well as referred from the rest part of the country for better management of their diagnoses, breast cancer.

The majority of breast cancer cases included in the current study had a loco-regionally advanced disease, stage III. Advanced disease at presentation is a common problem reported by studies from developing countries. Most breast cancer patients in the Sub-Saharan Africa present with stages III and IV of the disease [3, 19, 20]. A systematic review and meta-analysis study carried out to determine the proportion of early-stage breast cancer at the time of diagnosis in Ethiopian hospitals reported a pooled proportion of 36% (31%-41%), an estimate significantly lower than the target set by the Global Breast Cancer Initiative of the World Health Organization [19].

Of the three SF-36 scales developed to measure the different aspects of physical health, bodily pain was found to be statistically significantly lower in the post-mastectomy group of this study. Prior studies showed that women with breast cancer commonly suffer from pain with far reaching consequences including a reduction in quality of life [44]. Chronic pain after mastectomy is a frequently encountered experience [28]. It has several contributing components including the extent of the surgical procedure, radiotherapy and psychosocial factors. Compared to breast conserving surgery, mastectomy is associated with a higher incidence and magnitude of pain. A more extensive dissection of the axilla is also a strong predictor of post-surgery pain among such patients [45]. Our study participants had several of the factors strongly contributing to the development and magnitude of pain in breast cancer. Their type of surgery was a more extensive one with no reconstruction attempts, modified radical mastectomy. The psychosocial burden and its contribution to the pain of losing their breasts are also expected to be higher as evidenced with their lower scores in the SF-36 scales measuring the different aspects of mental health. The PF was lower in the post-mastectomy group; however, the difference was not significant. The score for RP was equal between the two groups. The fact that nearly half of them had early-stage breast cancer; their relatively younger age and the lower rate of comorbidities among them can contribute to these findings.

In the current study, the standardized scores of the three SF-36 scales that measure the different aspects of mental health (SF, RE and MH) were found to be significantly lower among post-mastectomy cases than controls. The RE of cases was half of that of the controls. Similarly, prior studies showed that women face huge mental health challenges and burden accompanying the diagnosis of breast cancer. The emotional journey after receiving the diagnosis of breast cancer has thorny ups and downs. These all can occur before, during and after treatment [46, 47]. Mental disorders were more common in breast cancer patients than controls [45, 46, 48]. A systematic review by Carreia, et al. [29]. which included sixty studies concluded that breast cancer survivors had increased risk of depression, anxiety, suicide, and sexual and neurocognitive dysfunctions.

Many different factors have been reported by several studies to influence mental health after breast cancer diagnosis. Endocrine therapies like tamoxifen were found to be associated with increased rate of mental disorders [46]. Most studies found that lesser extent of breast surgery and oncoplastic breast surgeries improve psychological outcomes [49, 50]. The behavioral and emotional changes that breast cancer patients experience reduce quality of life [47]. Scars and other lasting body changes following treatment of breast cancer make women feel less attractive and have less self-acceptance [51, 52]. The post-mastectomy group of our study had several factors that can contribute to the lower RE and MH. The more extensive breast surgery even when they had an early breast cancer that could be treated with breast-conserving surgery due to scarce availability and less affordability of radiotherapy; no practice of breast reconstruction after mastectomy; sense of being not optimally treated due to scarcity of several treatment options and the long waiting list to obtain the available services; the bare availability of breast cancer survivorship and support groups; and losing the breasts at a relatively younger age are among the factors worth mentioning.

The social functioning of cases in our study was lower than that of the controls. Sperlich S, et al. [53] reported that breast cancer patients after primary surgery had lower social participation compared to the general population. It also showed that breast cancer patients after a mastectomy had a higher likelihood to have a lower degree of social participation compared to those who had breast conserving surgery. A narrow social network among breast cancer cases negatively impacts their long-term outcomes like morbidity, mortality and quality of life [54]. It is also positively correlated with psychological distress [55, 56]. The more extensive surgery they had; the diversified socio-cultural characteristics; their relatively lower educational level and other factors might contribute to the lower social functioning of the post-mastectomy group in our study. Negative body image and the subsequent psychological burden that they experience as a result of loss of their breasts can also be mentioned as an important contributing factor. Yoo JJ, et al. [57]. showed that the extent of surgery, educational level and other socio-demographic and cultural characteristics of cancer patients influence the perception of their body appearance; and mastectomy cases reported a more negative body image than those for whom breast-conserving surgery was done.

The study had important limitations worth reporting. One, though the SF-36 is a widely validated tool worldwide and it has been and can be applied in different scenarios and populations [40, 41], it is not yet validated in the Ethiopian setting. Two, for logistical constraints, women in the control group were recruited from those visiting the study area for breast screening. These women may not be a representative of the diversified Ethiopian population which intern narrows the generalizability of the findings of the study to a wider Ethiopian context. Three, the fact that the study is a single-center study might not reflect the variations that could be captured from a multi-center study. Four, even though there is no a population-based norm based on age in the study area to assess the effect of age on the quality-of-life outcomes, the age difference might also contribute for the differences in Hr-QoL outcomes between the study groups. Therefore, we encourage readers to take in to account these limitations when interpreting the study findings.

Conclusion

Quality of life of breast cancer patients after a curative-intent surgery was found to be lower. The post-mastectomy group scored significantly lower values in all of the scales measuring mental health and those measuring both physical and mental health. Of the three scales measuring physical health, bodily pain was found to be significantly lower. The study provides a barely available data on measures of health-related quality of life outcomes on post-operative breast cancer individuals compared with health institution-based clients from a resource-limited setting. The findings contribute to improvements in pre- and post-operative counseling and understanding among providers and breast cancer cases about the expectations; and it also helps in assessing the effectiveness and quality of healthcare interventions and programs. Optimal treatment and an organized psychosocial and emotional support by establishing, strengthening and expanding cancer survivorship and support groups can improve such low outcome measures.

Abbreviations

BP

Bodily Pain

CHC

Churchill Health Center

CI

Confidence Interval

GH

General Health

Hr-QoL

Health-related Quality of Life

IQR

Inter-Quartile Range

MH

Mental Health

MRM

Modified Radical Mastectomy

PF

Physical Health

Q1

First Quartile

Q3

Third Quartile

RE

Role-Emotional

RHT

Reported Health Transition

RP

Role-Physical

Sd

Standard Deviation

SF-36

Medical Outcomes Study Questionnaire Short Form 36

SF

Social Functioning

SPSS

Statistical Package for Social Sciences

TASH

Tikur Anbessa Specialized Hospital

VT

Vitality

Authors’ contributions

Conceptualization: ABB; Methodology: ABB; Formal analysis: ABB, EAA, GTB; Data interpretation: ABB, EAA, GTB; Supervision: ABB, EAA, GTB; Visualization: ABB, EAA, GTB; Writing-original draft: ABB; Writing-review and editing: ABB, EAA, GTB; Final approval of the version to be published: ABB, EAA, GTB.

Funding

This research has been partially funded by Addis Ababa University (DOS/566/24/16; Invoice number: 12954; Supplementary file 3). The funder has no any role in the study design, data collection, analysis and submission for publication of the study.

Data availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This research project has been given an ethical clearance from Research & Ethics Committee of Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University as part of a research on “Elective Endocrine and Breast Surgical Procedures: Health-Related Quality of Life Outcomes and Patients’ Experiences: A Mixed Methods Study” (Protocol number: DOS/REC/101/2024/2016; Supplementary file 2). An informed written consent from participants during the interviewer-administered questionnaire and an oral consent during the phone calls were obtained and identifying data of the participants have been held confidential. The study protocol was carried out in accordance with the declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.