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Clinical Trial
. 2025 Jul 1;8(7):e2518887.
doi: 10.1001/jamanetworkopen.2025.18887.

Quality of Life Among Patients With Ductal Carcinoma In Situ

Victoria J Dunsmore  1 , Bradley S Snyder  2 , Ilana F Gareen  3 , Constance D Lehman  4 , Seema A Khan  5 , Justin Romanoff  2 , Constantine Gatsonis  6 , Ralph L Corsetti  7 , Habib Rahbar  8 , Derrick W Spell  9 , Linda K Han  10 , John R Bumberry  11 , Kathy D Miller  10 , Joseph A Sparano  12 , Christopher Comstock  13 , Elyse Park  4 , Lynne I Wagner  1 , Ruth C Carlos  14
Affiliations
Clinical Trial

Quality of Life Among Patients With Ductal Carcinoma In Situ

Victoria J Dunsmore et al. JAMA Netw Open. .

Abstract

Importance: Limited longitudinal data exist regarding health-related quality of life (HRQL) following surgery for ductal carcinoma in situ (DCIS) breast cancer.

Objective: To assess individual- and neighborhood-level factors associated with longitudinal trajectories of mental and physical HRQL among individuals with DCIS eligible for breast conservation surgery.

Design, setting, and participants: This cohort study was an ancillary to a prospective, nonrandomized clinical trial of women with DCIS breast cancer between March 2015 and April 2016 at 75 US institutions, community practices, and academic centers coordinated by the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group (E4112). Eligible participants were recently diagnosed with unilateral DCIS who were eligible for wide local excision (WLE) and had a diagnostic mammogram within 3 months of study registration. Patient-reported outcome (PRO) questionnaires were administered to participants at the time of registration, after surgeon consultation but presurgery, at the first postoperative visit, 12 months postsurgery, and 24 months postsurgery. Self-reported social determinants of health (SDOH) and clinical history and surgery received were also collected. Data were analyzed from June 2024 to November 2024.

Main outcomes and measures: PRO measures assessing patient knowledge of DCIS and perception of being informed; HRQL, measured using the 10-item Patient-Reported Outcomes Measurement Information System with mental and physical health subscales.

Results: Among the 296 women, the median age at enrollment was 60 years (range, 34-87 years) (11 Asian [4%], 41 Black [14%], 229 White [77%]); 147 participants (50%) reported at least 1 family member with breast cancer. The majority of participants had non-Hispanic ethnicity (280 [95%]), had private insurance (227 [77%]), resided in areas of low-to-moderate deprivation (ADI median, 44 [range, 1-99]), and received a single WLE (185 [63%]). Participants exhibited good knowledge of DCIS (median, 80 [range, 20-100]) and a high perception of being informed (median, 10 [range, 3-10]). Being American Indian or Alaska Native, Asian, Black, multiracial, or not reporting race (χ2 = 6.8 [df, 2]; P = .03), having insurance other than private (χ2 = 14.3 [df, 2]; P < .001), and having more than 1 surgery (χ2 = 12.3 [df, 4]; P = .02) were associated with decreases in mental health at 24 months compared with baseline. Having private insurance and a low perception of being informed of one's treatment were associated with increases in physical health at 2 years.

Conclusions and relevance: In this cohort study of women with DCIS, in the 24 months following diagnosis, nonprivate insurance, minoritized race, and number of surgeries received were associated with reduced mental HRQL. Nonprivate insurance was also associated with reduced physical HRQL.

Trial registration: ClinicalTrials.gov Identifier: NCT02352883.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dunsmore reported grants from National Cancer Institute's (NCI) National Research Service Award (No. T32 CA116339) outside the submitted work. Mr Snyder reported grants from Brown University School of Public Health to aid statistical analysis performed under the aegis of Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) during the conduct of the study. Dr Lehman reported grants from GE Healthcare, consultant fees from Hologic, and a role as cofounder and consultant with Clairity outside the submitted work. Dr Khan reported advisory work with Hahah Therapeutics outside the submitted work. Dr Romanoff reported grants from NCI's National Clinical Trials Network (No. U10CA180794) during the conduct of the study. Dr Rahbar reported grants from National Institutes of Health (NIH)/NCI funds to institution and grants from Guerbet, LLC outside the submitted work; he reported consulting fees from Guerbet, LLC outside the submitted work; he reported support for role as co-investigator in a prior study not related to this work or topic supported by GE Healthcare; he reported travel support to attend the ECOG-ACRIN and European Society of Breast Imaging meetings; and he reported receiving an honoraria to teach at the American College of Radiology Education Center outside the submitted work. Dr Han reported honoraria from Hologic and Cardinal Health outside the submitted work. Dr Comstock reported consulting fees from Bayer Medical and Recentric Healthcare Technologies outside the submitted work. Dr Wagner reported consulting fees from Celgene/Bristol Myers Squibb outside the submitted work. Dr Carlos reported grants from ECOG-ACRIN during the conduct of the study; she reported salary support from American College of Radiology as editor in chief of Journal of the American College of Radiology; she reported receiving a speaker honorarium from Canon Medical; she reported receiving travel reimbursement from the Radiological Society of North America, Association of Academic Radiology, GE Medical, and The Academy of Radiology and Biomedical Imaging Research outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
HRQL indicates health-related quality of life; MRI, magnetic resonance imaging; PRO, patient-reported outcome; PROMIS-10, 10-Item Patient Reported Outcomes Measurement Information System.
Figure 2.
Figure 2.. Model-Based Longitudinal Trajectories of the PROMIS-10 Mental T Score by Race, Insurance Status, and Type of Surgery
D, White with 1 WLE vs non-White (American Indian or Alaska Native, Asian, Black, multiple races, and not reported or unknown) with >1 surgery, P < .001; White with mastectomy vs non-White with >1 surgery, P = .03; White with >1 surgery vs non-White with >1 surgery, P = .051; non-White with 1 WLE vs non-White with >1 surgery, P = .04. PROMIS-10 indicates 10-item Patient-Reported Outcomes Measurement Information System.
Figure 3.
Figure 3.. Model-Based Longitudinal Trajectories of the PROMIS-10 Physical T Score by Insurance Status and Perception of Being Informed
PROMIS-10 indicates 10-item Patient-Reported Outcomes Measurement Information System.
See this image and copyright information in PMC

References

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