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. 2023 Nov 1;278(5):e1096-e1102.
doi: 10.1097/SLA.0000000000005920. Epub 2023 May 26.

Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction

Kevin Diao  1 , Xiudong Lei  2 , Weiguo He  2 , Reshma Jagsi  3 , Sharon H Giordano  2   4 , Grace L Smith  5 , Abigail Caudle  6 , Yu Shen  7 , Susan K Peterson  8 , Benjamin D Smith  1   2
Affiliations

Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction

Kevin Diao et al. Ann Surg. .

Abstract

Objective: To compare long-term quality of life (QOL) outcomes in breast cancer survivors who received breast-conserving surgery with radiotherapy (BCS+RT) with those who received a mastectomy and reconstructive surgery (Mast+Recon) without radiotherapy and identify other important factors.

Background: The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood.

Methods: We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed in 2009-2014 after BCS+RT or Mast+Recon without radiotherapy. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points.

Results: Of 1215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis, Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size: -3.80, P =0.04) and sexual well-being (effect size: -5.41, P =0.02), but better PROMIS physical function (effect size: 0.54, P =0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function ( P >0.05) compared with BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains.

Conclusions: Patients who underwent Mast+Recon reported worse long-term sexual well-being compared with BCS+RT. Older patients derived a greater benefit from BCS+RT, while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision-making for women with early-stage breast cancer.

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Conflict of interest statement

B.D.S. receives salary support from Varian Medical Systems that is unrelated to the current project. He also has a royalty and equity interest in Oncora Medical. R.J.’s time on this work was supported by the Susan G. Komen Foundation. Outside the current work, she has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; she has received personal fees from the Greenwall Foundation, Doris Duke Charitable Foundation, and the National Institutes of Health and grants or contracts for unrelated work from the National Institutes of Health, the Doris Duke Charitable Foundation, the American Cancer Society, the Greenwall Foundation, and Genentech. She has served as an expert witness for Dressman Benzinger LaVelle and Kleinbard LLC. The remaining authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Adjusted BREAST-Q and PROMIS scores for mastectomy and autologous reconstruction (Autologous), implant reconstruction (Implant), or breast conserving surgery and radiotherapy (BCS+RT). Error bars represent 95% confidence intervals compared to referent group BCS+RT. * indicates a statistically and clinically significant difference compared to BCS+RT.
Figure 2
Figure 2
Adjusted BREAST-Q and PROMIS scores for bilateral reconstruction (Two Reconstructed breasts), unilateral reconstruction (One Reconstructed Breast), or breast conserving surgery and radiotherapy (BCS+RT). Error bars represent 95% confidence intervals compared to referent group BCS+RT. * indicates a statistically and clinically significant difference compared to BCS+RT.
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References

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