Basing healthcare decisions on value: patient-reported outcomes for patients diagnosed with breast cancer in a European cohort

Abstract

Improvements in breast cancer survival rate have been achieved through a variety of multimodal therapeutic approaches, which play a key role in the patients' healthcare pathway and their Patient-Reported Outcomes (PROs) from a Value-Based Healthcare (VBHC) perspective. This paper analyses differences in PROs of patients diagnosed with breast cancer according to their healthcare pathway. A cohort of 690 patients diagnosed with breast cancer between 2018 and 2020 at six European sites was used. PROs were assessed at baseline and 6 months using the International Consortium for Health Outcome Measures standard set. Archetypes defined by patient characteristics and treatment trajectories served as the basis for comparison. Multivariate linear regression models were used to analyse differences in PROs across archetypes. Functional scores generally worsened over 6 months, particularly in physical functioning, whereas emotional functioning improved. Archetypes undergoing mastectomy, with or without reconstruction, showed significant decreases in body image perception and satisfaction with breasts. Pain, fatigue, and peripheral symptoms were prevalent in most archetypes, with those receiving chemotherapy reporting the greatest symptom burden. Patients with in situ carcinoma and patients undergoing conservative surgery plus radiotherapy showed minimal deterioration. The use of PROs in a real-world setting enables the identification of differences across patient archetypes based on their therapeutic pathways. This information provides valuable insights for refining patient-centred care guiding VBHC strategies in oncology, developing of personalized care solutions, and facilitating Shared-Decision Making.

Figure 1.

Crude PROs’ evolution by archetype. Baseline vs. 6-month.^{a a}Detail of figures available in Table S1; ^bhigh scores represent high level of symptomatology; ^cscale ranges between 0 and 20; ^dscale ranges between 0 and 4.

Figure 2.

Adjusted comparison of PROs across archetypes at 6-month follow-up.^{a a}All analyses controlled for age, site, archetype, menopause, comorbidity and PRO value at baseline. Arch-1 is the reference archetype; ^bhigh score represents high level of symptomatology; ^cscale ranges between 0 and 20; ^dscale ranges between 0 and 4.