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A Prospective Evaluation Of Breast Cancer Patient Perception Of The Physical Wellbeing Of The Chest
Feras Shamoun, BSc, Benita Hosseini, PhD, David Lim, MD, Isabel Kerrebijn, BSc, Stefan Hofer, MD, PhD, Anne O'Neill, MD, PhD, Kelly Metcalfe, RN, PhD, Toni Zhong, MD, MHS.
University Health Network, Toronto, ON, Canada.

PURPOSE:
Surgical management options for breast cancer, including breast-conserving therapy, mastectomy alone, and mastectomy with immediate or delayed breast reconstruction, have the potential for associated chest and upper body morbidity including chronic pain, paresthesia, and impairment of shoulder and arm mobility. The primary aim of this study is to prospectively evaluate chest and upper body physical well-being in women with breast cancer before and following three surgical approaches: breast conserving surgery (BCS), mastectomy alone (MA), and mastectomy with immediate breast reconstruction (IBR)
METHODS:
A prospective cohort study of women with stage 0-III breast cancer was conducted at University Health Network in Toronto, Canada between 2014- 2020. The primary outcome was BREAST-Q chest physical well-being subdomain, completed pre-operatively (T0), and at 6- and 12-months following surgery (T1 and T2, respectively). Change in chest well-being scores was assessed between surgical groups (BCS, MA, IBR) using linear mixed models, controlling for age, ethnicity, and adjuvant treatments. P values < .05 were considered significant.
RESULTS:
In the overall cohort, 452 patients were identified. Of those patients, 197 (43.6%) underwent BCS, 122 (27%) underwent MA, and 133 (29.4%) underwent IBR. There was a significant interaction (P<0.01) between surgical intervention and time for chest well-being after adjusting for age, ethnicity, chemotherapy, radiotherapy and endocrine therapy. At baseline, BCS patients had significantly higher BREAST-Q chest physical well-being scores with a median (IQR) score of 100 (80,100) compared with MA and IBR groups with median scores of 76 (66,85) and 81 (68,91), respectively (P<0.0001). At T1, while there was no significant difference between BCS and IBR groups with medians of 72 (59,81) and 68 (60,77), respectively, both groups had significantly higher scores compared with MA patients with median scores of 60 (53,71) (P<0.0001). This trend was sustained at T2, with BCS and IBR having median scores of 72 (64,86) and 74 (63,81), respectively, compared with MA having a median score of 63 (53,74) (P<0.0001). Within-group comparisons revealed significantly higher BCS scores at T0 compared with T1 and T2 (P<0.0001), with no significant difference between T1 and T2. A similar trend was also noted in the IBR group with higher baseline scores compared with T1 and T2 (P<0.0001), and no significant difference between T1 and T2. Conversely, in the MA group, there was a significant decrease in median scores from T0 76 (66,85) to T1 60 (53,71) (P<0.0001); scores did improve at T2 63 (53,74) (P=0.028) but did not return to T0 levels (P=0.018)
CONCLUSION:
Chest physical well-being decreases in breast cancer patients after undergoing surgical intervention, as seen in all three surgical groups. Patients that perceive their baseline chest physical well-being more positively may be more inclined to undergo breast conservation. Women undergoing mastectomy alone experience the greatest decreases in chest physical well-being. Moreover, immediate breast reconstruction at the time of mastectomy appears to improve chest physical well-being. These data should be considered by women having mastectomy for breast cancer treatment and wishing to optimize their future chest physical well-being


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