Comparison of mastectomy and breast reconstruction versus conservative surgery with radiation

1. At 10-year follow-up, patients with early-stage breast cancer who underwent mastectomy with breast reconstruction had similar breast outcome satisfaction and physical well-being, but worse psychosocial and sexual well-being, when compared to patients who underwent breast-conserving surgery with radiation therapy (RT).

Evidence Rating Level: 2 (Good)

Study Rundown: For patients with early-stage breast cancer, options for treatment include breast-conserving surgery with radiation therapy (RT) or mastectomy with breast reconstruction if desired. Although cancer recurrence and survival are similar between the two, there is a lack of data comparing the long-term quality of life outcomes for patients who chose either treatment. Therefore, this current study examined 10-year outcomes for these two treatments, with regards to patient satisfaction, functioning, and well-being. The study cohort was taken from the Texas Cancer Registry, and surveys were mailed to patients who had breast cancer Stages 0 to 2. Overall, the study found that there were no differences in patient satisfaction with the outcome of the breasts, as well as no differences in physical well-being or regret. However, psychosocial and sexual well-being were both significantly lower for the mastectomy and reconstruction patients than the conservative surgery and RT patients.

Click here to read the study in JAMA Surgery

Relevant Reading: Patient-reported Quality of Life and Satisfaction With Cosmetic Outcomes After Breast Conservation and Mastectomy With and Without Reconstruction

In-Depth [Survey]: The study population consisted of 647 patients, comprising a 40.0% response rate to the survey. Of those 647, 55% had underwent conservative surgery and RT, whereas 45% had mastectomy and reconstruction. The median age was 53, and 60.7% identified as racial minorities. The survey used the BREAST-Q patient outcome measure, which had scales measuring satisfaction with the breast, physical well-being, psychosocial well-being, and sexual well-being. Other measures used in the survey include the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level (EQ-5D-3L) questionnaire, used to produce a health utility score, and the Decisional Regret Scale, used to measure regret surrounding the treatment choice made. After a median follow-up of 10.3 years, there was no difference in breast satisfaction (effect size 2.71, 95% CI -2.45 to 7.88, p = 0.30) and physical well-being (effect size -1.80, 95% CI -5.65 to 2.05, p = 0.36). There was also no difference in health utility score as measured with the EQ-5D-3L questionnaire (effect size -0.003, 95% CI -0.03 to 0.03, p = 0.83) nor was there a difference in decisional regret (effect size 1.32, 95% CI -3.77 to 6.40, p = 0.61). However, the mastectomy and reconstruction patients had significantly worse psychosocial well-being (effect size -8.61, 95% CI -13.26 to -3.95, p < 0.001) and sexual well-being (effect size -10.68, 95% CI -16.60 to -4.76, p < 0.001). Altogether, this data provides insight into the long-term quality of life outcomes for both treatments, contributing to better informed patient decision-making.

Image: PD

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