Meeting NewsPerspective

Surgery choice affects quality of life among younger patients with breast cancer

SAN ANTONIO — Local therapy decisions appeared to significantly affect quality of life among young breast cancer survivors, according to study results presented at San Antonio Breast Cancer Symposium.

Patients who underwent mastectomy reported poorer psychosocial and sexual well-being and lower breast satisfaction that patients who underwent breast-conserving surgery, results showed.

“Knowledge of the potential long-term impact of surgery on quality of life is of critical importance for counseling young women about surgical decisions,” Laura S. Dominici, MD, FACS, surgeon at Dana-Farber/Brigham and Women’s Cancer Center, assistant professor of surgery at Harvard Medical School and division chief of breast surgery at Brigham and Women’s Faulkner Hospital, said during a press conference.

Approximately 75% of women with breast cancer are eligible for breast-conserving surgery. However, an increasing percentage — particularly younger women — are opting to undergo bilateral mastectomy. Oncologic outcomes often are equivalent, so quality-of-life should be a key component of the physician-patient decision-making process, Dominici said.

Dominici and colleagues evaluated quality-of-life outcomes among young women who underwent breast-conserving surgery, unilateral mastectomy and bilateral mastectomy.

Researchers sent BREAST-Q — a validated patient-reported outcomes survey — to 743 women diagnosed with breast cancer by age 40 who were enrolled in a large prospective cohort study; of these women, 584 (79%) completed the survey.

The final analysis included 560 women, 72% of whom underwent mastectomy (bilateral, 52%; unilateral, 20%) and 28% of whom had breast-conserving surgery. A majority (89%) of women underwent reconstructive surgery. Nearly all women (99%) who underwent breast-conserving surgery received radiation, as did 45% of those who underwent mastectomy.

Median time from diagnosis to BREAST-Q completion was 5.8 years (range, 1.9-10.4).

Most survey respondents were white (90%) and married (77%). The majority had been diagnosed with stage 0 to stage II disease (86%), had comfortable financial status (79%), had a college degree (86%), and had undergone chemotherapy (72%) or endocrine therapy (66%). Nearly one-third (32%) had BMI of 25 or higher.

Results showed patients who underwent breast-conserving therapy had significantly higher mean BREAST-Q scores than those who underwent bilateral mastectomy or unilateral mastectomy with regard to breast satisfaction (65.5 vs. 60.4 vs. 59.3; P = .008), psychosocial well-being (75.9 vs. 68.4 vs. 70.6; P < .001) and sexual well-being (57.4 vs. 49 vs. 53.4; P < .001)

Researchers reported no difference in physical well-being between groups.

Multivariate analysis showed that, compared with breast-conserving surgery, mastectomy was significantly associated with significantly poorer satisfaction with breasts (P < .001 for unilateral and bilateral), psychosocial well-being (P = .001 for unilateral; P < .001 for bilateral) and sexual well-being (P < .001 for bilateral).

Compared with women who identified themselves as financially comfortable, those who indicated they were financially uncomfortable had significantly poorer satisfaction with breasts (P = .02), physical well-being (P = .004), psychosocial well-being (P = .003) and sexual well-being (P = .004).

The researchers acknowledged the study was limited by the fact it was not randomized, and that it only evaluated quality of life at one time point. In addition, investigators did not have information about survey respondents’ quality of life before the study, which may have influenced their decision-making and their quality of life after surgery.

“These findings suggest that surgical choices may have long-term impact on quality of life,” Dominici said in a press release. “We really need to have more data about quality of life, particularly after surgery, because this information can help shape their decisions.”

Additional research could help clinicians better advise patients about their surgical options, she added.

“In the future, I am hopeful that we will be able to predict quality-of-life outcome for an individual patient following the different types of surgery in order to help her decide what is best for her,” Dominici said. – by Mark Leiser

 

Reference:

Dominici LS, et al. Abstract GS6-06. Abstract GS4-01. Presented at: San Antonio Breast Cancer Symposium; Dec. 4-8, 2018; San Antonio.

 

Disclosure:

Agency for Healthcare Research and Quality, Susan G. Komen, Breast Cancer Research Foundation and The Pink Agenda funded this study. Dominici reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

SAN ANTONIO — Local therapy decisions appeared to significantly affect quality of life among young breast cancer survivors, according to study results presented at San Antonio Breast Cancer Symposium.

Patients who underwent mastectomy reported poorer psychosocial and sexual well-being and lower breast satisfaction that patients who underwent breast-conserving surgery, results showed.

“Knowledge of the potential long-term impact of surgery on quality of life is of critical importance for counseling young women about surgical decisions,” Laura S. Dominici, MD, FACS, surgeon at Dana-Farber/Brigham and Women’s Cancer Center, assistant professor of surgery at Harvard Medical School and division chief of breast surgery at Brigham and Women’s Faulkner Hospital, said during a press conference.

Approximately 75% of women with breast cancer are eligible for breast-conserving surgery. However, an increasing percentage — particularly younger women — are opting to undergo bilateral mastectomy. Oncologic outcomes often are equivalent, so quality-of-life should be a key component of the physician-patient decision-making process, Dominici said.

Dominici and colleagues evaluated quality-of-life outcomes among young women who underwent breast-conserving surgery, unilateral mastectomy and bilateral mastectomy.

Researchers sent BREAST-Q — a validated patient-reported outcomes survey — to 743 women diagnosed with breast cancer by age 40 who were enrolled in a large prospective cohort study; of these women, 584 (79%) completed the survey.

The final analysis included 560 women, 72% of whom underwent mastectomy (bilateral, 52%; unilateral, 20%) and 28% of whom had breast-conserving surgery. A majority (89%) of women underwent reconstructive surgery. Nearly all women (99%) who underwent breast-conserving surgery received radiation, as did 45% of those who underwent mastectomy.

Median time from diagnosis to BREAST-Q completion was 5.8 years (range, 1.9-10.4).

Most survey respondents were white (90%) and married (77%). The majority had been diagnosed with stage 0 to stage II disease (86%), had comfortable financial status (79%), had a college degree (86%), and had undergone chemotherapy (72%) or endocrine therapy (66%). Nearly one-third (32%) had BMI of 25 or higher.

Results showed patients who underwent breast-conserving therapy had significantly higher mean BREAST-Q scores than those who underwent bilateral mastectomy or unilateral mastectomy with regard to breast satisfaction (65.5 vs. 60.4 vs. 59.3; P = .008), psychosocial well-being (75.9 vs. 68.4 vs. 70.6; P < .001) and sexual well-being (57.4 vs. 49 vs. 53.4; P < .001)

Researchers reported no difference in physical well-being between groups.

Multivariate analysis showed that, compared with breast-conserving surgery, mastectomy was significantly associated with significantly poorer satisfaction with breasts (P < .001 for unilateral and bilateral), psychosocial well-being (P = .001 for unilateral; P < .001 for bilateral) and sexual well-being (P < .001 for bilateral).

Compared with women who identified themselves as financially comfortable, those who indicated they were financially uncomfortable had significantly poorer satisfaction with breasts (P = .02), physical well-being (P = .004), psychosocial well-being (P = .003) and sexual well-being (P = .004).

The researchers acknowledged the study was limited by the fact it was not randomized, and that it only evaluated quality of life at one time point. In addition, investigators did not have information about survey respondents’ quality of life before the study, which may have influenced their decision-making and their quality of life after surgery.

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“These findings suggest that surgical choices may have long-term impact on quality of life,” Dominici said in a press release. “We really need to have more data about quality of life, particularly after surgery, because this information can help shape their decisions.”

Additional research could help clinicians better advise patients about their surgical options, she added.

“In the future, I am hopeful that we will be able to predict quality-of-life outcome for an individual patient following the different types of surgery in order to help her decide what is best for her,” Dominici said. – by Mark Leiser

 

Reference:

Dominici LS, et al. Abstract GS6-06. Abstract GS4-01. Presented at: San Antonio Breast Cancer Symposium; Dec. 4-8, 2018; San Antonio.

 

Disclosure:

Agency for Healthcare Research and Quality, Susan G. Komen, Breast Cancer Research Foundation and The Pink Agenda funded this study. Dominici reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

    Perspective

    This study shows mastectomy is commonly used and it often is bilateral — at least in this sample of younger women — with the majority of women getting implant-based reconstruction. This raises the issue of radiation and how that may be modifying the cosmetic and other outcomes.

    Mastectomy appeared associated with poorer satisfaction with breasts, as well as poorer psychosocial well-being and sexual functioning. The issue of being financially uncomfortable also is a really important variable because the costs — not only in financial [terms] but in time — for women who undergo reconstruction is very substantial.

    There is no question that mastectomy leads to increased body image and sexual difficulties after a breast cancer diagnosis. This is more severe for this group than for women who have breast-conserving surgery, although there are women who undergo breast-conserving surgery who are unhappy with the results of their treatment. If women who opt to have bilateral mastectomy to reduce their fear of recurrence and reduce their anxiety, it does not seem to be evident in terms of the psychosocial well-being assessment.

    How a woman feels about her body after breast cancer surgery is a very important driver of sexual and emotional well-being. This is often moderated by age. Clinicians need to prepare patients for the likely disruption in body image that occurs with any breast cancer surgery and how this may potentially impact many aspects of her quality of life.

    In the haste of trying to help patients make decisions, we don’t spend as much time talking about breast cancer surgery outcomes and how that fits into the whole package of therapy that we are recommending.


    • Patricia A. Ganz, MD
    • Jonsson Comprehensive Cancer Center, University of California, Los Angeles

    Disclosures: Ganz reports no relevant financial disclosures.

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