How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes.
Body image
Breast cancer
Breast-conserving surgery
Chemotherapy
Endocrine therapy
Immediate breast reconstruction
Mastectomy
Patient-reported outcomes
Radiotherapy
Real-world data
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
28 Jul 2023
28 Jul 2023
Historique:
received:
04
05
2023
accepted:
12
07
2023
medline:
31
7
2023
pubmed:
29
7
2023
entrez:
28
7
2023
Statut:
epublish
Résumé
In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
Sections du résumé
BACKGROUND
BACKGROUND
In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL.
METHODS
METHODS
EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time.
RESULTS
RESULTS
BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101).
CONCLUSIONS
CONCLUSIONS
Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
Identifiants
pubmed: 37507687
doi: 10.1186/s12885-023-11172-y
pii: 10.1186/s12885-023-11172-y
pmc: PMC10375629
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
705Informations de copyright
© 2023. The Author(s).
Références
Breast Care (Basel). 2016 Feb;11(1):28-32
pubmed: 27051393
Ann Surg Oncol. 2014 Jul;21(7):2159-64
pubmed: 24740825
JAMA Surg. 2020 Nov 1;155(11):1035-1042
pubmed: 32936216
Arch Gynecol Obstet. 2010 Jul;282(1):75-82
pubmed: 19960349
Eur J Cancer. 2000 Oct;36(15):1938-43
pubmed: 11000574
Nurs Res. 1993 May-Jun;42(3):153-7
pubmed: 8506164
J Natl Cancer Inst. 1993 Mar 3;85(5):365-76
pubmed: 8433390
Ann Oncol. 2003 Jul;14(7):1064-71
pubmed: 12853348
J Natl Cancer Inst Monogr. 2006;(36):112-21
pubmed: 17032901
Eur J Oncol Nurs. 2014 Apr;18(2):206-10
pubmed: 24201014
J Clin Oncol. 1996 Oct;14(10):2756-68
pubmed: 8874337
Cancer Nurs. 2016 Jan-Feb;39(1):E39-58
pubmed: 25881807
J Clin Oncol. 2004 Oct 1;22(19):4002-9
pubmed: 15459224
Psychooncology. 2000 May-Jun;9(3):183-92
pubmed: 10871714
Psychooncology. 2006 Jul;15(7):579-94
pubmed: 16287197
N Engl J Med. 1985 Mar 14;312(11):665-73
pubmed: 3883167
J Surg Oncol. 2017 Jun;115(8):941-948
pubmed: 28334419
N Engl J Med. 2002 Oct 17;347(16):1227-32
pubmed: 12393819
J Clin Oncol. 1998 Jan;16(1):139-44
pubmed: 9440735
Cancer. 2010 Aug 1;116(15):3549-57
pubmed: 20564138
Cancer. 2001 Sep 1;92(5):1288-98
pubmed: 11571745
Psychooncology. 2018 Dec;27(12):2815-2822
pubmed: 30225915
Eur J Oncol Nurs. 2010 Sep;14(4):263-70
pubmed: 20493769
Breast. 2007 Aug;16(4):396-410
pubmed: 17368026
Breast Cancer. 2023 Mar;30(2):226-240
pubmed: 36319889
JMIR Cancer. 2018 Dec 20;4(2):e11373
pubmed: 30573450
Psychooncology. 2013 Aug;22(8):1872-9
pubmed: 23203842
Psychooncology. 2011 Feb;20(2):115-26
pubmed: 20336645
J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1377-1385
pubmed: 28712883
Eur J Surg Oncol. 2021 Jul;47(7):1581-1587
pubmed: 33593622
Plast Reconstr Surg. 2013 Dec;132(6):1658-1669
pubmed: 24281592
Eur J Cancer. 2001 Jan;37(2):189-97
pubmed: 11166145
Maturitas. 2010 Aug;66(4):397-407
pubmed: 20439140
Ann Plast Surg. 2016 Nov;77(5):517-522
pubmed: 28792427
J Natl Cancer Inst. 2016 Sep 27;109(1):
pubmed: 27678203
N Engl J Med. 2002 Oct 17;347(16):1233-41
pubmed: 12393820
JAMA Oncol. 2017 May 1;3(5):677-685
pubmed: 28033439
Plast Reconstr Surg. 2003 Mar;111(3):1060-8
pubmed: 12621175
J Clin Oncol. 2019 Feb 1;37(4):305-317
pubmed: 30532984
Cancer. 2014 Aug 1;120(15):2237-46
pubmed: 24891116
Ann Surg Oncol. 2021 Dec;28(13):8742-8751
pubmed: 34279753
Eur J Surg Oncol. 2009;35 Suppl 1:1-22
pubmed: 19299100
Breast. 2007 Jun;16(3):241-51
pubmed: 17236771
Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:153-158
pubmed: 30195967
Breast J. 2004 May-Jun;10(3):223-31
pubmed: 15125749
J Cancer Surviv. 2018 Feb;12(1):127-133
pubmed: 29043480
J Pers Assess. 1995 Jun;64(3):466-77
pubmed: 16367722
Breast Cancer Res Treat. 2012 Feb;131(3):957-67
pubmed: 21971728
N Engl J Med. 2001 Jun 28;344(26):1997-2008
pubmed: 11430330
Plast Reconstr Surg. 2007 May;119(6):1669-1676
pubmed: 17440339
PLoS One. 2017 Nov 8;12(11):e0187165
pubmed: 29117210
Eur J Cancer. 2021 Feb;144:269-280
pubmed: 33373871
Ann Oncol. 2019 Aug 1;30(8):1194-1220
pubmed: 31161190
Eur J Surg Oncol. 2018 Jul;44(7):963-968
pubmed: 29678302
Cancer. 2012 Apr 15;118(8 Suppl):2217-25
pubmed: 22488696
Eur J Cancer. 2009 Jul;45(11):1916-23
pubmed: 19398327
Psychooncology. 2013 Aug;22(8):1849-55
pubmed: 23132765
N Engl J Med. 2008 Oct 9;359(15):1590-601
pubmed: 18843123