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Patient-Reported Outcomes After Same-Day Mastectomy Among Older Breast Cancer Patients: Results From a Prospective
Jessica C Gooch1,2, Qi Ying McClelland3, Kathryn Paschalis3
1Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.
Background:
The safety and value of same-day mastectomy are well-documented but the patient perspective is underreported, especially among older patients. This study aimed to investigate older patient-reported recovery quality after mastectomy; we hypothesized that patients who were discharged same day would report better recovery.
Methods:
A prospective trial included frailty screening and prehabilitation for patients age ≥ 65 undergoing mastectomy for breast cancer. Primary endpoint, same-day discharge rate, was previously reported and was significantly higher than the year prior. Secondary endpoint was patient-reported postoperative recovery quality, per the Quality of Recovery-15 measure (QoR-15; 15 questions scored 1-10, 10 being best). Patients responded by phone 24-72 h postdischarge. One-tailed T-tests compared responses between same-day and admitted patients.
Results:
37/55 (67.3%) patients ≥ 65 who underwent unilateral/bilateral mastectomy for early-stage breast cancer responded. Mean age was 73.6 (standard deviation 7.6), most had invasive carcinoma (44, 80.0%), and mean 5-factor Modified Frailty Index (mFI-5) was 1.3 of 5 (standard deviation 0.9); nonresponders had similar characteristics. There were no significant differences in any QoR-15 item (all p > 0.05). In fact, most responses were very similar, different by only one-tenth of 1 point or identical. The following answers slightly (0.2 difference or more) numerically favored same-day discharge: feeling rested, having good sleep, less moderate pain, and freedom from feeling anxious or depressed. No items favored admission.
Conclusions:
Although this trial was not powered for secondary analyses, it is clinically meaningful that older patients undergoing same-day mastectomy reported similar recovery quality as those admitted. Same-day mastectomy should be considered for older patients.
