Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients.
Adult
Aged
Aged, 80 and over
Breast Neoplasms
/ surgery
Cross-Sectional Studies
Female
Health Status
Humans
Mammaplasty
/ statistics & numerical data
Mastectomy
/ statistics & numerical data
Mastectomy, Segmental
/ statistics & numerical data
Middle Aged
Netherlands
Patient Reported Outcome Measures
Patient Satisfaction
Postoperative Complications
Quality of Life
Retrospective Studies
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
entrez:
27
6
2020
pubmed:
27
6
2020
medline:
15
8
2020
Statut:
ppublish
Résumé
Differences in quality-of-life outcomes after different surgical breast cancer treatment options, including breast reconstruction, are relevant for counseling individual patients in clinical decision-making, and for (societal) evaluations such as cost-effectiveness analyses. However, current literature shows contradictory results, because of use of different patient-reported outcome measures and study designs with limited patient numbers. The authors set out to improve this evidence using patient-reported outcome measures in a large, cross-sectional study for different surgical breast cancer treatment options. Quality of life was assessed through the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23, and the BREAST-Q. Patients with different treatments were compared after propensity-weighted adjustment of pretreatment differences. The EQ-5D was used to value the effect of surgical complications. A total of 1871 breast cancer patients participated (breast-conserving surgery, n = 615; mastectomy, n = 507; autologous reconstruction, n = 330; and implant-based reconstruction, n = 419). Mastectomy patients reported the lowest EQ-5D score (mastectomy, 0.805, breast-conserving surgery, 0.844; autologous reconstruction, 0.849; and implant-based reconstruction, 0.850) and functioning scores of the C30 questionnaire. On the BREAST-Q, autologous reconstruction patients had higher mean Satisfaction with Outcome, Satisfaction with Breasts, and Sexual Well-being scores than implant-based reconstruction patients. Complications in autologous reconstruction patients resulted in a substantially lower quality of life than in implant-based reconstruction patients. This study shows the added value of breast conservation and reconstruction compared with mastectomy; however, differences among breast-conserving surgery, implant-based reconstruction, and autologous breast reconstruction were subtle. Complications resulted in poorer health-related quality of life.
Sections du résumé
BACKGROUND
Differences in quality-of-life outcomes after different surgical breast cancer treatment options, including breast reconstruction, are relevant for counseling individual patients in clinical decision-making, and for (societal) evaluations such as cost-effectiveness analyses. However, current literature shows contradictory results, because of use of different patient-reported outcome measures and study designs with limited patient numbers. The authors set out to improve this evidence using patient-reported outcome measures in a large, cross-sectional study for different surgical breast cancer treatment options.
METHODS
Quality of life was assessed through the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23, and the BREAST-Q. Patients with different treatments were compared after propensity-weighted adjustment of pretreatment differences. The EQ-5D was used to value the effect of surgical complications.
RESULTS
A total of 1871 breast cancer patients participated (breast-conserving surgery, n = 615; mastectomy, n = 507; autologous reconstruction, n = 330; and implant-based reconstruction, n = 419). Mastectomy patients reported the lowest EQ-5D score (mastectomy, 0.805, breast-conserving surgery, 0.844; autologous reconstruction, 0.849; and implant-based reconstruction, 0.850) and functioning scores of the C30 questionnaire. On the BREAST-Q, autologous reconstruction patients had higher mean Satisfaction with Outcome, Satisfaction with Breasts, and Sexual Well-being scores than implant-based reconstruction patients. Complications in autologous reconstruction patients resulted in a substantially lower quality of life than in implant-based reconstruction patients.
CONCLUSIONS
This study shows the added value of breast conservation and reconstruction compared with mastectomy; however, differences among breast-conserving surgery, implant-based reconstruction, and autologous breast reconstruction were subtle. Complications resulted in poorer health-related quality of life.
Identifiants
pubmed: 32590633
doi: 10.1097/PRS.0000000000006887
pii: 00006534-202007000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-13Références
Janssen-Heijnen ML, van Steenbergen LN, Voogd AC, et al. Small but significant excess mortality compared with the general population for long-term survivors of breast cancer in the Netherlands. Ann Oncol. 2014;25:64–68.
Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975-2014. Available at: https://seer.cancer.gov/csr/1975_2014/. Accessed November 17, 2018.
van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: A population-based study. Lancet Oncol. 2016;17:1158–1170.
Fischer B, Andersen S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–1241.
Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13:412–419.
Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med. 2008;359:1590–1601.
Netherlands Comprehensive Cancer Organisation. National guideline on breast cancer. Available at: https://www.oncoline.nl/uploaded/docs/mammacarcinoom/Dutch%20Breast%20Cancer%20Guideline%202012.pdf. Accessed November 17, 2018.
Senkus E, Kyriakides S, Ohno S, et al.; ESMO Guidelines Committee. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v8–v30.
Mureau MAM; Breast Reconstruction Guideline Working Group. Dutch breast reconstruction guideline. J Plast Reconstr Aesthet Surg. 2018;71:290–304.
Tondu T, Tjalma WAA, Thiessen FEF. Breast reconstruction after mastectomy. Eur J Obstet Gynecol Reprod Biol. 2018;230:228–232.
Damen TH, Wei W, Mureau MA, et al. Medium-term cost analysis of breast reconstructions in a single Dutch centre: A comparison of implants, implants preceded by tissue expansion, LD transpositions and DIEP flaps. J Plast Reconstr Aesthet Surg. 2011;64:1043–1053.
Bennett KG, Qi J, Kim HM, Hamill JB, Pusic AL, Wilkins EG. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg. 2018;153:901–908.
Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, Faucher A. Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthet Surg. 2006;59:1017–1024.
Robertson S, Wengström Y, Eriksen C, Sandelin K. Breast surgeons performing immediate breast reconstruction with implants: Assessment of resource-use and patient-reported outcome measures. Breast 2012;21:590–596.
Jeevan R, Cromwell DA, Browne JP, et al. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg. 2014;67:1333–1344.
Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: A systematic review. Eur J Cancer 2005;41:2613–2619.
Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J Natl Cancer Inst. 2002;94:39–49.
Tan ML, Idris DB, Teo LW, et al. Validation of EORTC QLQ-C30 and QLQ-BR23 questionnaires in the measurement of quality of life of breast cancer patients in Singapore. Asia Pac J Oncol Nurs. 2014;1:22–32.
Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res. 2018;27:2077–2086.
Sun Y, Kim SW, Heo CY, et al. Comparison of quality of life based on surgical technique in patients with breast cancer. Jpn J Clin Oncol. 2014;44:22–27.
Lee C, Sunu C, Pignone M. Patient-reported outcomes of breast reconstruction after mastectomy: A systematic review. J Am Coll Surg. 2009;209:123–133.
Santosa KB, Qi J, Kim HM, Hamill JB, Wilkins EG, Pusic AL. Long-term patient-reported outcomes in postmastectomy breast reconstruction. JAMA Surg. 2018;153:891–899.
Versteegh MM, Vermeulen KM, Evers SMAA, de Wit GA PR, Stolk EA. Dutch tariff for the five-level version of EQ-5D. Value Health 2016;19:343–352.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–376.
Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. J Clin Oncol. 1996;14:2756–2768.
Fayers PM, Aaronson NK, Bjordal K, et al. The EORTC QLQ-C30 Scoring Manual. 2001.3rd ed. Brussels, Belgium: European Organisation for Research and Treatment of Cancer;
Cano SJ, Klassen AF, Scott AM, Pusic AL. A closer look at the BREAST-Q. Clin Plast Surg. 2013;40:287–296.
McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med. 2013;32:3388–3414.
RAND Corp. Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) (computer program). 2014.Santa Monica, Calif: RAND Corp;
StataCorp. STATA Survey Data Reference Manual. 2015.College Station, Texas: StataCorp;
StataCorp. Stata Statistical Software: Release 14 (computer program). 2015.College Station, Texas: StataCorp;
Eltahir Y, Werners LL, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg. 2013;132:201e–209e.
Thorarinsson A, Fröjd V, Kölby L, Ljungdal J, Taft C, Mark H. Long-term health-related quality of life after breast reconstruction: Comparing 4 different methods of reconstruction. Plast Reconstr Surg Glob Open 2017;5:e1316.
Cocks K, King MT, Velikova G, Martyn St-James M, Fayers PM, Brown JM. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. J Clin Oncol. 2011;29:89–96.
Gopie JP, Timman R, Hilhorst MT, Hofer SO, Mureau MA, Tibben A. The short-term psychological impact of complications after breast reconstruction. Psychooncology 2013;22:290–298.
Higgins KS, Gillis J, Williams JG, LeBlanc M, Bezuhly M, Chorney JM. Women’s experiences with flap failure after autologous breast reconstruction: A qualitative analysis. Ann Plast Surg. 2017;78:521–525.
Timman R, Gopie JP, Brinkman JN, et al. Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study. PLoS One 2017;12:e0174455.
Lu SM, Nelson JA, Fischer JP, et al. The impact of complications on function, health, and satisfaction following abdominally based autologous breast reconstruction: A prospective evaluation. J Plast Reconstr Aesthet Surg. 2014;67:682–692.
de Ligt KM, van Bommel ACM, Schreuder K, et al.; NABON Breast Cancer Audit Working Group. The effect of being informed on receiving immediate breast reconstruction in breast cancer patients. Eur J Surg Oncol. 2018;44:717–724.
Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–1736.
Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. McIntosh E, Clarke P, Frew EJ, Louviere JJ. Measuring, valuing, and analysing health outcomes. In: Applied Methods of Cost-Effectiveness Analysis in Health Care. 2011:Oxford: Oxford University Press; 86–116.
Porter ME, Teisberg EO. How physicians can change the future of health care. JAMA 2007;297:1103–1111.
Berlin NL, Hamill JB, Qi J, Kim HM, Pusic AL, Wilkins EG. Nonresponse bias in survey research: Lessons from a prospective study of breast reconstruction. J Surg Res. 2018;224:112–120.