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Baseline Differences in Patient-Reported Quality of Life Across Breast Cancer Surgical Pathways
Abigail Teitelbaum1,2, Summer Sami Yono3,4, Wing Lee Cheung4,5
1Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA. abigail.teitelbaum2@corewellhealth.org.
Background:
Advancements in breast cancer treatment have led to excellent survival outcomes, shifting focus toward patient-centered measures. Although patient-reported outcomes (PROs), particularly the BREAST-Q©, are increasingly used to evaluate these domains, most studies focus on postoperative outcomes with limited assessment of baseline differences across surgical options. This study evaluated whether preoperative PROs differ among patients undergoing various surgical treatments.
Methods:
We performed a prospective cohort study of women aged ≥ 18 years with newly diagnosed stage I-III disease undergoing surgery from 2017 to 2024. Participants completed preoperative BREAST-Q© modules based on planned procedure: lumpectomy, lumpectomy with oncoplastic reduction mammoplasty, unilateral mastectomy, bilateral mastectomy, unilateral mastectomy with reconstruction (UMR), or bilateral mastectomy with reconstruction. Domains assessed included satisfaction with breasts, psychosocial, physical chest, and sexual well-being. PRO scores were compared across procedure types, and regression analysis evaluated associations between preoperative scores and surgical procedure.
Results:
In total, 561 patients completed preoperative surveys. Significant baseline differences in PROs were observed across groups. On univariate analysis, all PRO domains except physical chest well-being differed significantly by procedure type. Multivariable analysis demonstrated that lower preoperative breast satisfaction and sexual well-being scores were associated with lumpectomy with oncoplastic reduction mammoplasty, bilateral mastectomy with reconstruction, and UMR compared with lumpectomy. Lower physical chest wall well-being was associated with unilateral mastectomy, and lower psychosocial well-being was associated with UMR.
Conclusion:
Significant preoperative differences in PROs exist across procedures. Incorporating PRO measures into preoperative evaluation may improve shared decision-making and individualized patient care.