Learning from the QUEST multicentre feasibility randomization trials in breast reconstruction after mastectomy

Area of Science:

• Oncology
• Plastic Surgery
• Clinical Trials

Background:

• Breast reconstruction aims to enhance quality of life post-mastectomy.
• Limited evidence exists for shared decision-making on optimal breast reconstruction type and timing.
• Patient preferences significantly influence choices in reconstructive surgery.

Purpose of the Study:

• To assess the feasibility of randomized trials on latissimus dorsi breast reconstruction.
• To evaluate the impact of reconstruction type and timing on quality of life.
• To understand patient and healthcare professional acceptability of trial participation.

Main Methods:

• Two parallel feasibility phase III randomized multicentre trials (QUEST A and B) were conducted.
• QUEST A: reconstruction when postmastectomy radiotherapy is unlikely.
• QUEST B: reconstruction when postmastectomy radiotherapy is highly probable.
• A companion QUEST Perspectives Study (QPS) assessed trial acceptability.

Main Results:

• Recruitment rates were lower than the 25% feasibility target (QUEST A: 19%, QUEST B: 22%).
• Patient preference was the primary reason for declining trial participation (53-61% of declines).
• Both trials closed due to challenges in achieving satisfactory patient accrual.

Conclusions:

• It was not feasible to meet recruitment targets within the feasibility study timeframe.
• Strong patient preferences for specific breast reconstruction methods and schedules hindered trial enrollment.
• Further strategies are needed to facilitate shared decision-making and trial participation in breast reconstruction research.