Patient Reported Outcomes in Breast Cancer: A Plea for the Silent and Forgotten

Area of Science:

• Oncology
• Surgical Oncology
• Patient-Reported Outcomes

Background:

• Growing research on patient-reported outcomes (PROs) for breast conserving surgery (BCS) and mastectomy with reconstruction (MR).
• Limited data exists for PROs following mastectomy alone (MA).
• Patient procedural choice is preference-based, underscoring the importance of PROs for informed decision-making.

Purpose of the Study:

• To evaluate and compare patient-reported outcomes (PROs) across three breast cancer surgical procedures: BCS, MA, and MR.
• To assess patient participation rates in PRO data collection for these procedures.

Main Methods:

• Prospective enrollment of 199 patients with unilateral, nonrecurrent breast cancer (June 2020 - September 2023).
• Administration of the BREAST-Q (BQ) survey preoperatively (Q1), 2-6 weeks postoperatively (Q2), and 1 year postoperatively (Q3).
• Utilization of forced multiple regression analyses to compare postoperative BQ scores.

Main Results:

• A participation rate of 73.4% (146/199) was achieved.
• Mastectomy alone (MA) showed lower satisfaction with breast scores than BCS but was equivalent to mastectomy with reconstruction (MR).
• Physical well-being was similar across all procedures; psychosocial well-being was lower after MR but not MA.
• Preoperative BQ scores strongly correlated with postoperative scores across all domains.

Conclusions:

• Breast conserving surgery (BCS) yielded the highest patient satisfaction and quality of life.
• Mastectomy alone (MA) demonstrated noninferior outcomes compared to mastectomy with reconstruction (MR).
• Improving patient participation in PROs is crucial for robust study conclusions, generalizability, and comparative analysis, particularly for MA patients.