Breast Conservation Yields Equal QOL Outcomes to Mastectomy and Reconstruction Among Patients With Breast Cancer
Patients with early stage breast cancer were as satisfied with their breasts and had a similar sense of physical well-being after either breast-conserving surgery with radiation therapy or mastectomy and reconstruction without radiation therapy, according to results of a comparative effectiveness research study done at MD Anderson Cancer Center in Houston, TX (JAMA Surgery. 2022. Published online April 13. doi:10.1001/jamasurg.2022.0631). However, the study also found that breast-conserving surgery with radiation therapy was associated with meaningful improvements in psychosocial and sexual well-being.
“These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer,” wrote Benjamin Smith, MD, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, and colleagues.
To conduct this study, the researchers used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. Their objective was to evaluate the results in terms of long-term quality of life from treatment with breast-conserving surgery with radiation therapy compared with mastectomy and reconstruction without radiation therapy. Patients selected to participate in the study received a survey between March 2017 and April 2018, and the survey data were analyzed from August 2018 to October 15, 2021.
The primary outcome of the study was satisfaction with breasts as reflected in the BREAST-Q patient-reported outcome (PRO) measure. Secondary outcomes were physical well-being, psychosocial well-being, and sexual well-being as reflected in this PRO measure. Other secondary outcomes included health utility measured with the EuroQol Health-Related Quality of Life 5-Dimension 3-Level Questionnaire and patient regret regarding their decision about local therapy.
The researchers used multivariable linear regression models weighted for treatment, age, and race and ethnicity to test associations between exposure and outcomes.
A total of 647 patients, or 40% of those contacted, responded to the survey. Of those, 356 received breast-conserving surgery, and 291 had a mastectomy and reconstruction. The median age of these patients was 53 years (range, 23 yr to 85 yr) and their median time from diagnosis to completion of the survey was 10.3 years (range, 8.4 yr to 12.5 yr).
Of the 647 respondents, 551 (85%) confirmed that they had received either breast-conserving surgery with radiation therapy (n=315) or mastectomy and reconstruction without radiation therapy (n=236).
Results of multivariable analysis indicated no difference in satisfaction with breasts between breast-conserving surgery with radiation therapy, which was designated the reference treatment, and mastectomy and reconstruction without radiation therapy (effect size [ES], 2.7; 95% confidence interval [CI], -2.5 to 7.9; P=0.3 ) or in physical well-being (ES, -1.8; 95% CI, -5.7 to 2.1; P=0.36).
However, psychosocial well-being and sexual well-being were worse after mastectomy and reconstruction without radiation therapy than after breast-conserving surgery with radiation therapy. For psychosocial well-being, this ES was -8.6 (95% CI, -13.3 to -4.0; P<.001), and for sexual well-being, this ES was -10.7 (95% CI, -16.6 to -4.8; P<.001). No difference was found between treatment groups with regard to health utility and regret about the local treatment decision.
