V20: Who Are We Missing: Does Engagement in Patient Reported Outcome Measures (PROM) for Breast Cancer Vary by Age, Race, and Disease Stage?

Introduction: Patient Reported Outcome Measures (PROM) are increasingly used to assess value-based care, but little is known about whether PROM response in breast cancer reflects the diversity of the patient population. The BREAST-Q, a validated measure of satisfaction and quality of life, and the Recovery Tracker (RT), a postoperative assessment tool, are PROM routinely delivered to all patients undergoing breast surgery at our institution. Our aim was to determine if response to PROM differ by age, ethnicity, race, language, or disease stage.


Methods: All patients who had a breast operation between 01/2020 – 07/2021 were eligible and requested to complete the BREAST-Q (sent weekly initially) and RT (sent daily). Responders (R) completed 1 or more of the PROM, whereas non-responders (NR) did not complete the PROM at any timepoint. Primary outcomes included rates of R vs. NR overall and by specific PROM. Univariate and multivariate analysis were used to compare patient and tumor characteristics between R vs. NR.


Results: Of the 6,374 patients identified, 5,653 (88.7%) responded to either PROM; 4366/4751 (91.9%) to BREAST-Q and 2746/3384 (81.1%) to RT. On univariate analysis, NR compared to R were older (60yrs vs 55 yrs;p< 0.001) more often identified as non-English speaking (p< 0.001), Hispanic ethnicity (p=0.031), and Black race (p< 0.001) [Table]. On multivariable analysis NR were significantly more likely to identify as Black race and non-English speaking [Table]. Non-English speakers were significantly less responsive among all ethnicities and races except Black race. Although breast cancer stage, available only for BREAST-Q, did not reach statistical significance for response, patients with malignant disease (p< 0.001) and those receiving neoadjuvant chemotherapy were more likely to respond (p=0.014)(Table).


Conclusions:

Our findings demonstrate high patient engagement using two different PROM following breast surgery, but suggest that PROM results may not reflect the experience of the entire breast cancer population. Changes in processes of care based solely on PROM could enhance dissatisfaction with care among racial and ethnic minorities and older patients.