Breast
Laura Dominici, MD
Associate Surgeon
Dana Farber, Brigham and Women's Cancer Center
Boston, MA, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
There is limited data available on long-term patient-reported outcomes (PROs) in patients (pts) undergoing breast-conserving surgery (BCS).
Methods: Patients treated for stage 0-III breast cancer who had surgery at our institution from 2002-2012 and agreed to be recontacted, were invited to participate in a cross-sectional PRO study. Pts reporting chemotherapy within 6 months of receiving the survey were excluded. Physical, psychological, sexual well-being (WB) and satisfaction with breasts (SWB) using BREAST-Q (0-100, higher is better) were collected and examined for BCS pts. Multivariable linear regression was performed to identify factors associated with PRO scores, adjusting for age, time since surgery, anatomic stage, molecular subtype, receipt of systemic therapy, radiation (RT), locoregional recurrence (LRR) or contralateral breast cancer (CBC).
Results:
1127 patients replied to invitation to participate, and 78% completed ≥1 BREAST-Q domain. Among 562 pts who underwent BCS, 437 (78%) responded; median time from surgery was 10.4yrs (IQR: 8.0-13.5). Median age at surgery was 53yrs, ≥90% were white, had upfront surgery for early-stage disease and completed adjuvant RT. There were 11 (2%) LRR and 20 (5%) CBCs.
BREAST-Q score distribution is shown in the Figure. In adjusted analyses, age as a continuous variable was associated with all WB domains (all p< 0.04). Relative to age 50-59, women age 30-39 and 40-49 had notably lower psychological (β -6.4/-4.3) and sexual WB (β -4.3/-3.8). Women age 30-39 also had lower SWB (β -8.4). Longer time since surgery was associated with higher sexual WB and SWB (β 0.8/0.7 per year, p=0.04/0.03). Larger tumor size was associated with lower psychological WB and SWB (β -5.77/-7.29 for T2 vs. T1, p=0.03/0.01).
Conclusions: BCS pts had excellent physical and psychological WB at a median of >10yrs from surgery, with greater variation observed for sexual WB and satisfaction with breasts. This study provides PRO reference values for pts treated with BCS which will inform interpretation of PROs for individual pts as well as future PRO studies.