Prospective Evaluation of Quality of Life for Patients with Breast Cancer Treated with Breast Conserving Surgery, Mastectomy Alone and Mastectomy with Immediate Breast Reconstruction
Helene Retrouvey, MDCM1, Toni Zhong, MD, MHS, FRCS(C)2.
1University of Toronto, Toronto, ON, Canada, 2Toronto General Hospital, Toronto, ON, Canada.
PURPOSE: To evaluate the change in satisfaction and quality of life between early breast cancer patients treated with breast conserving surgery (BCT), mastectomy alone (MA) or mastectomy with immediate breast reconstruction (IBR) at one year after surgery using the BREAST-Q.
METHODS: All early stage (Stage 0-2) breast cancer patients treated at a single tertiary care center between 2015 and 2017 were enrolled. Their quality of life and satisfaction outcomes were compared using the BREAST-Q breast satisfaction (BS) and psychosocial well being (PSW) scales at 12 months. A multivariate linear regression was performed to assess changes in BS and PSW scores between baseline and 12 months. Clinically relevant and statistically different baseline factors were incorporated in the multivariable model; these include age, income, education, ethnicity, cancer stage and laterality.
RESULTS: A total of 242 early stage breast cancer patients (Stage 0-2) were prospectively enrolled; 107 underwent BCT, 56 MA and 79 IBR. Patient's in the BCT group were older at baseline (60 ±11 years old) compared to MA (52 ±12 years) or IBR (49±10 years) (p<0.0001). The majority of IBR cases were bilateral (66%), whereas they comprised only 32% of MA and 5% of BCT (p<0.0001). Education, income, and ethnicity were comparable between groups at baseline. The three groups had similar baseline BS and PSW scores (p=0.17 and p=0.71). At 12 months, BCT had the highest BREAST-Q scores, with 68/100 for BS and 79/100 for PSW (p<0.0001), compared to, respectively, 57 and 65 for IBR, and 48 and 57 for MA. After multivariable regression accounting for patient's age, income, education, ethnicity, cancer stage and laterality, BS BREAST-Q change from baseline to 12 months was not statistically different for BCT and IBR (p=0.0662), while MA patients experienced lower BS compared to BCT (p<0.0001). IBR patients had no different BS when compared to MA (p=0.16). With regards to PSW, similar patterns were present. IBR patients had no different PSW than BCT (p=0.25), while MA patients experienced lower wellbeing compared to BCT (p<0.0001). IBR had higher PSW compared to MA (p=0.0039).
CONCLUSION: This large prospective study highlights that changes in breast satisfaction and psychosocial wellbeing at 12 months for BCT and IBR are no different in early stage breast cancer patients, but are significantly reduced in MA. This study is the first to compare BREAST-Q outcomes between BCT, MA and IBR, and provides important evidence to support the use of BCT and IBR to optimize long-term quality of life and breast satisfaction for early stage breast cancer patients.
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