Patient Reported Outcomes in Breast Cancer: A Plea for the Silent and Forgotten

Abstract

Background: There are an increasing number of reports addressing patient reported outcomes (PRO's) following breast conserving surgery (BCS) and mastectomy with reconstruction (MR), but few addressing mastectomy alone (MA). Patients' choice of procedure is often preference-based, making PRO's essential to inform decision making. The current research aims to evaluate PRO's associated with all three surgical procedures, along with patient participation rates.

Methods: Patients with unilateral, nonrecurrent breast cancer were prospectively enrolled in the study (June 2020 to September 2023). Participants received the BREAST-Q (BQ) survey preoperatively (Q1), 2 to 6 weeks (Q2) and 1 year (Q3) postoperatively. Forced multiple regression analyses were performed to compare postoperative BQ scores.

Results: 199 patients were eligible, with 73.4% (146/199) participating in the study. While MA had lower satisfaction with breast scores than BCS (B = -11.6), they were equivalent to those of MR (B = -16.5), with similar pathologic and treatment related factors. Physical well being was similar between all three procedures, while psychosocial well being scores were lower following MR (B = -15.5), but not MA. Patient age, BMI, and tumor size variably impacted BQ scores, but preoperative BQ scores independently correlated with postoperative scores across all domains.

Conclusion: Patient response rates are consistent with the literature, but require improvement to ensure meaningful conclusions, generalizability of results, and comparisons between studies. Patients undergoing BCS reported the highest satisfaction and quality of life, with MA being noninferior to MR. Efforts to increase patient participation in PRO's are required, especially in those undergoing MA.

Keywords: BREAST-Q; Breast conserving surgery; Breast surgery; Mastectomy; Quality of life.