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Multicenter Study
. 2021 Oct 1;156(10):e213758.
doi: 10.1001/jamasurg.2021.3758. Epub 2021 Oct 13.

Association of Local Therapy With Quality-of-Life Outcomes in Young Women With Breast Cancer

Laura Dominici  1   2 , Jiani Hu  3 , Yue Zheng  3 , Hee Jeong Kim  4   5 , Tari A King  1 , Kathryn J Ruddy  6 , Rulla M Tamimi  7 , Jeffrey Peppercorn  8 , Lidia Schapira  9 , Virginia F Borges  10 , Steven E Come  11 , Ellen Warner  12 , Julia S Wong  13   14 , Ann H Partridge  4 , Shoshana M Rosenberg  4
Affiliations
Multicenter Study

Association of Local Therapy With Quality-of-Life Outcomes in Young Women With Breast Cancer

Laura Dominici et al. JAMA Surg. .

Erratum in

  • Error in the Abstract.
    [No authors listed] [No authors listed] JAMA Surg. 2021 Oct 1;156(10):989-990. doi: 10.1001/jamasurg.2021.5506. JAMA Surg. 2021. PMID: 34643683 Free PMC article. No abstract available.

Abstract

Importance: Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown.

Objective: To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors.

Design, setting, and participants: This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study.

Exposures: Primary breast surgery, reconstruction, and radiotherapy.

Main outcomes and measures: Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain.

Results: A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P = .007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P < .001).

Conclusions and relevance: These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr King reported receiving speaker’s fees from and serving on an advisory board for Exact Sciences (formerly Genomic Health) and serving as information service faculty and on the virtual tumor board for Precisca Cancer outside the submitted work. Dr Peppercorn reported having a spouse who is an employee of GlaxoSmithKline outside the submitted work. Dr Rosenberg reported receiving grants from the Agency for Healthcare Research and Quality, Breast Cancer Research Foundation, and Susan G. Komen Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Unadjusted BREAST-Q Mean Scores by Local Therapy Strategy
BCT indicates breast-conserving therapy; BMx, bilateral mastectomy; RT, radiation therapy; UMx, unilateral mastectomy.
Figure 2.
Figure 2.. Patient and Treatment Factors Associated With BREAST-Q Scores
Error bars indicate 95% CIs. BCT indicates breast-conserving therapy; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); RT, radiation therapy.
Figure 3.
Figure 3.. Unadjusted BREAST-Q Mean Scores by Reconstruction Type
RT indicates radiation therapy.
Figure 4.
Figure 4.. Patient and Treatment Factors Associated With BREAST-Q Score Among Women Who Underwent Mastectomy With Reconstruction
Error bars indicate 95% CIs. BMI indicates body mass index.
See this image and copyright information in PMC

Comment in

References

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