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. 2022 Jun 1;157(6):e220631.
doi: 10.1001/jamasurg.2022.0631. Epub 2022 Jun 8.

Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction

Summer E Hanson  1 , Xiudong Lei  2 , Margaret S Roubaud  1 , Sarah M DeSnyder  3 , Abigail S Caudle  3 , Simona F Shaitelman  4 , Karen E Hoffman  4 , Grace L Smith  2   4 , Reshma Jagsi  5 , Susan K Peterson  6 , Benjamin D Smith  2   4
Affiliations

Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction

Summer E Hanson et al. JAMA Surg. .

Abstract

Importance: Treatment options for early breast cancer include breast-conserving surgery with radiation therapy (RT) or mastectomy and breast reconstruction without RT. Despite marked differences in these treatment strategies, little is known with regard to their association with long-term quality of life (QOL).

Objective: To evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-term QOL.

Design, setting, and participants: This comparative effectiveness research study used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. The study sample was mailed a survey between March 2017 and April 2018. Data were analyzed from August 1, 2018 to October 15, 2021.

Exposures: Breast-conserving surgery with RT or mastectomy and reconstruction without RT.

Main outcomes and measures: The primary outcome was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. Secondary outcomes included BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. Multivariable linear regression models with weights for treatment, age, and race and ethnicity tested associations of the exposure with outcomes.

Results: Of 647 patients who responded to the survey (40.0%; 356 had undergone breast-conserving surgery, and 291 had undergone mastectomy and reconstruction), 551 (85.2%) confirmed treatment with breast-conserving surgery with RT (n = 315) or mastectomy and reconstruction without RT (n = 236). Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years). Multivariable analysis showed no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71; 95% CI, -2.45 to 7.88; P = .30) or physical well-being (effect size, -1.80; 95% CI, -5.65 to 2.05; P = .36). In contrast, psychosocial well-being (effect size, -8.61; 95% CI, -13.26 to -3.95; P < .001) and sexual well-being (effect size, -10.68; 95% CI, -16.60 to -4.76; P < .001) were significantly worse with mastectomy and reconstruction without RT. Health utility (effect size, -0.003; 95% CI, -0.03 to 0.03; P = .83) and decisional regret (effect size, 1.32; 95% CI, -3.77 to 6.40; P = .61) did not differ by treatment group.

Conclusions and relevance: The findings support equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Roubaud reported receiving personal fees from Mentor LLC and Checkpoint Surgical outside the submitted work. Dr Caudle reported receiving grants from the Cancer Prevention and Research Institute of Texas during the conduct of the study. Dr Shaitelman reported receiving grants from the Emerson Collective Foundation and the National Institutes of Health (NIH) and having contracted research agreements with Alpha Tau, Exact Sciences, TAE Life Sciences, and Artios Pharma outside the submitted work. Dr Hoffman reported receiving research funding from Varian Medical Systems and Janssen outside the submitted work. Dr G.L. Smith reported receiving grants from the National Cancer Institute (NCI) and research funding from the NIH outside the submitted work. Dr Jagsi reported receiving grants from the NIH, the Greenwall Foundation, Genentech, the Doris Duke Charitable Foundation, Komen Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium; receiving personal fees from the Doris Duke Charitable Foundation, the Greenwall Foundation, and the NIH as a member of the Advisory Committee for Research on Women’s Health; having stock options from Equity Quotient for service as an advisor outside the submitted work; having a contract to conduct an investigator-initiated study with Genentech; and serving as an expert witness for Sherinian & Hasso, Dressman Benzinger LaVelle, and Kleinbard LLC. Dr B.D. Smith reported receiving grants from the Cancer Prevention and Research Institute of Texas, the Andrew Sabin Family Foundation, and the NCI during the conduct of the study; receiving grants from Varian Medical Systems outside the submitted work; and having a royalty and equity interest in Oncora Medical. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Association of Breast-Conserving Surgery With Radiation Therapy (RT) vs Mastectomy and Breast Reconstruction Without RT With BREAST-Q Outcomes
Data are derived from adjusted linear regression models in Table 2. Markers represent effect sizes; error bars, 95% CIs; and vertical dashed lines, clinically significant difference in BREAST-Q score.
See this image and copyright information in PMC

Comment in

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