A National Snapshot of Satisfaction with Breast Cancer Procedures
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Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health.
Women recruited from the Army of Women with a history of breast cancer surgery took electronically administered surgery-specific surveys, including the BREAST-Q© and a background survey evaluating patient-, disease-, and procedure-specific factors. Descriptive statistics and regression analysis were used to evaluate the effect of procedure type on breast satisfaction scores.
Overall, 7,619 women completed the questionnaires. Linear regression revealed that women who underwent abdominal flap, or buttock or thigh flap reconstruction reported the highest breast satisfaction score, scoring an average of 5.6 points and 14.4 points higher than BCS, respectively (p < 0.0001 and p = 0.027, respectively). No difference in satisfaction was observed in women who underwent latissimus dorsi flap reconstruction compared with those who underwent BCS. Women who underwent implant reconstruction reported scores 8.6 points lower than BCS (p < 0.0001). Those with mastectomies without reconstruction or complex surgical histories scored, on average, 10 points lower than BCS (p < 0.0001).
Women who underwent autologous tissue reconstruction reported the highest breast satisfaction, while women undergoing mastectomy without reconstruction reported the lowest satisfaction. These findings emphasize the value of patient-reported outcome measures as an important guide to decision making in breast surgery and underscore the importance of multidisciplinary participation early in the surgical decision-making process.
KeywordsBreast Cancer Breast Reconstruction Contralateral Breast Contralateral Prophylactic Mastectomy Flap Reconstruction
We would like to acknowledge the AOW participants for volunteering to take this series of surveys in order to help improve and further our knowledge of outcomes associated with breast cancer care. The authors also acknowledge Andrea Pusic, MD, MPH, and the team of researchers at Memorial Sloan Kettering Cancer Center for providing us with the Breast Q©, and to Donald T. Kirkendall, ELS, for his assistance in the preparation of the manuscript. This study was supported by Grant #235066 from the Plastic Surgery Foundation.
- 8.US Food and Drug Administration. Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. Silver Spring (MD). 2009. http://www.fda.gov/downloads/Drugs/Guidances/UCM193282.pdf. Accessed 15 Apr 2014.
- 12.Cano SJ Klassen AF, Pusic AL. From BREAST-Q© to Q-Score©: using Rasch measurement to better capture breast surgery outcomes. Presented at the Joint International IMEDO TCI + TC7 + TC13 Symposium, 31 Aug–2 Sept 2011, Jena.Google Scholar
- 32.American College of Surgeons. National Accreditation Program for Breast Centers. http://napbc-breast.org/standards/standards.html.
- 34.Gopie JP, Hilhorst MT, Kleijne A, Timman R, Menke-Pluymers MB, Hofer SO, et al. Women’s motives to opt for either implant or DIEP flap breast reconstruction. J Plast Reconstr Surg. 2011;124(6): 1781–9.Google Scholar
- 35.Lin C, Zhunag Y, Momeni A, Luan J, Chung M, Wright E, et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient reported outcomes instrument Breast-Q. Breast Cancer Res Treat. 2014;146(1):117–26.CrossRefGoogle Scholar
- 36.Rosenberg SM, Tracy M, Meyer ME, Sepucha K, Gelber S, Hirschfield Bartek J, et al. (2013) Perceptions, knowledge and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med.;159(6):373–81.PubMedCentralPubMedCrossRefGoogle Scholar