Improvement In Quality Of Life Following Breast Reconstruction In Patients With Metastatic Breast Cancer
Geoffrey E. Hespe, MD, Niki Matsuko, BS, Jennifer B. Hamill, MPH, Jeffrey H. Kozlow, MD, MS, Edwin G. Wilkins, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Metastatic breast cancer makes up approximately 6% of all newly diagnosed breast cancer, but with enhancements in treatment options, more patients with advanced disease are living longer. While more advanced staged patients are undergoing breast reconstruction, there are few published reports on the benefits and risks of reconstruction in the setting of metastatic breast cancer. Such investigations are important in light of the potential impact of adjuvant cancer therapies on surgical complications and post-reconstruction quality of life. In this study, we assessed patient-reported outcomes (PROs) and risks of mastectomy reconstruction in patients with Stage IV breast cancer.
METHODS: This study utilized the Mastectomy Reconstruction Outcomes Consortium (MROC) data set, which prospectively collected data from 11 institutions from 2012 to 2015. Patient characteristics by groups and complications were analyzed using Chi-square tests and/or independent t-tests as appropriate. Single factor linear mixed models were used to account for hospital level clustering and to compare groups for satisfaction with breast, psychosocial well-being and sexual well-being using the Breast-Q at baseline (pre-reconstruction) and 2 years post reconstruction.
RESULTS: There were 26 MROC patients with Stage IV breast cancer and 2613 with Stage I-III disease (controls). There were no differences between the cohorts for mean age (control 50.1±9.9 versus 48.8±10.4 in the metastatic group), BMI, smoking status, race, ethnicity, income, marital status, or employment. There was no significant difference in radiation between groups, but there were significant differences in receipt of chemotherapy and in surgical evaluation of lymph node status. We evaluated PROs at baseline and 2 years. We found that metastatic patients had significantly lower baseline scores for satisfaction with breast (46.39 vs. 58.50; p<0.005), psychosocial well-being (61.28 vs. 68.27; p<0.05) and sexual well-being (38.16 vs. 53.08; P<0.001). Interestingly, at 2 years' post-reconstruction, there were no significant differences in scores between Stage IV and Stage I-III patients. Finally, evaluation of any (all), and major (requiring reoperation or re-hospitalization) complications demonstrated no difference between the control and metastatic cohort.
CONCLUSION: With improvements in treatment, patients with metastatic breast cancer are living longer, and more of them are undergoing breast reconstruction. We found that patients with Stage IV disease reported significant improvements in satisfaction with breast, psychosocial well-being and sexual well-being, with two-year PRO scores comparable to those of women with non-metastatic disease. Furthermore, disease stage had no significant effects on risks of complications. Although this study has some limitations (i.e. small sample size, possibility of confounding), we believe these data support the important role of breast reconstruction women with metastatic breast cancer.
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