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Patient-reported outcomes among women with unilateral breast cancer undergoing breast conservation versus single or double mastectomy

  • Preclinical study
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Abstract

Purpose

More women with unilateral early stage breast cancer are electing bilateral mastectomy (BM). Many cite anxiety, fear of recurrence, and certain aesthetic desires in their decision-making. Yet conflicting data exist regarding how these factors both inform and are modulated by medical decision-making, especially among women eligible for breast conservation (BCT). This study sought to assess the trajectories of women undergoing various surgical procedures for breast cancer.

Methods

We performed a prospective longitudinal study of women with unilateral, non-hereditary breast cancer who underwent BCT, unilateral mastectomy (UM), or BM. Women completed surveys before surgery and at 1, 9, and 15 months postop. Surveys included questions about treatment preferences, decisional control, the HADS-A anxiety scale, the Fear of Relapse/Recurrence Scale (FRRS), and the BREAST-Q. The Kruskal–Wallis test was used to compare outcomes between BCT, UM, and BM groups at each time point.

Results

203 women were recruited and 177 (87.2%) completed 15-month follow-up. Of these, 101 (57.0%) underwent BCT, 33 (18.6%) underwent UM, and 43 (24.2%) underwent BM. Generalized anxiety and FRRS scores were similar between BCT, UM, and BM groups and declined uniformly after surgery. Although baseline breast satisfaction was similar between groups, at 15 months, it was significantly lower in BM patients than in BCT patients. Women who felt “very” confident and “very” informed before surgery had lower anxiety, lower fear of recurrence, better psychosocial well-being (PSWB), and greater breast satisfaction at 15 months.

Conclusion

While patients who undergo mastectomy have less long-term breast satisfaction, all patients can expect to experience similar improvements in anxiety and PSWB. Efforts should be made to ensure that patients are informed and confident regardless of which surgery is chosen, for this is the greatest predictor of better outcomes.

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Funding

This study was funded by The Auxiliary of the NorthShore University HealthSystem 2014 Breast and Ovarian Research Program: Concept/Pilot Award Program. EH14-218.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, Evanston, IL, USA

    Catherine Pesce, Jennifer Jaffe & Katharine Yao

  2. Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA

    Kristine Kuchta

  3. Department of Surgery, Division of Plastic Surgery, NorthShore University HealthSystem, Northbrook, IL, USA

    Mark Sisco

Authors
  1. Catherine Pesce
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  2. Jennifer Jaffe
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  3. Kristine Kuchta
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  4. Katharine Yao
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  5. Mark Sisco
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Corresponding author

Correspondence to Mark Sisco.

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Conflict of interest

Author Pesce declares she has no conflict of interest. Author Jaffe declares she has no conflict of interest. Author Kuchta declares she has no conflict of interest. Author Yao declares she has no conflict of interest. Author Sisco is an advisor for and investor in Surgical Innovation Associates.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pesce, C., Jaffe, J., Kuchta, K. et al. Patient-reported outcomes among women with unilateral breast cancer undergoing breast conservation versus single or double mastectomy. Breast Cancer Res Treat 185, 359–369 (2021). https://doi.org/10.1007/s10549-020-05964-0

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  • DOI: https://doi.org/10.1007/s10549-020-05964-0

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