Abstract
Background.
It is unclear how patient-reported outcomes (PROs) change longitudinally after breast cancer surgery. We sought to compare trends in PROs among patients who underwent lumpectomy versus mastectomy over the first year after surgery.
Patients and Methods.
Newly diagnosed stage 0–III female patients with breast cancer who underwent lumpectomy or mastectomy at an academic breast center between June 2019 and March 2023 were invited to participate in a longitudinal PRO study. Enrolled patients received the BREAST-Q™ module, a validated tool measuring domains, such as satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Scores for each domain were compared between the lumpectomy and mastectomy groups over the first year after surgery. Linear mixed models were used to estimate the change in PRO scores over time.
Results.
The cohort included 203 who underwent lumpectomy and 144 who underwent mastectomy. Patients who underwent lumpectomy were older, more likely to receive adjuvant radiation and endocrine therapy, and less likely to receive adjuvant chemotherapy. Patients who underwent lumpectomy demonstrated greater increases in scores over time for satisfaction with breasts, psychosocial well-being, and sexual well-being compared with patients who underwent mastectomy, after adjusting for the abovementioned covariates and receipt of reconstruction. The lumpectomy group had a larger decline in physical well-being over time compared with the mastectomy group.
Conclusions.
Patients who underwent lumpectomy demonstrated greater satisfaction with their breasts, psychosocial well-being, and sexual well-being but worse physical well-being over the first year after surgery compared with patients who underwent mastectomy. These results may help inform early-stage breast cancer patients making decisions about their surgical care.
Keywords: Patient-reported outcomes, Lumpectomy, Mastectomy
BACKGROUND
Breast cancer may drastically alter the quality of life (QoL) of diagnosed patients in several ways. Patients may face distress from the new diagnosis, increased interactions with the healthcare system, familial or interpersonal relationships, symptoms associated with cancer and treatment effects, and decisions regarding breast cancer treatment.1 Thus, there has been an increased emphasis in evaluating the impact of breast cancer on patients’ QoL. Patient-reported outcomes (PROs) are patient’s perceptions of their own health, QoL, or functional status typically pertaining to receipt of health care.2 PROs represent a means for capturing how breast cancer treatment may impact patients’ QoL.
Surgery is an important treatment modality for patients with nonmetastatic breast cancer. Previous studies have shown that breast conserving therapy (BCT), or lumpectomy with adjuvant radiation therapy, offers similar survival when compared with mastectomy.3–5 There is also a growing body of evidence that suggests that BCT may be associated with superior PROs after surgery when compared with mastectomy.6–11 Despite these findings, women diagnosed with breast cancer are increasingly pursuing mastectomy rather than BCT.12 Prior studies have shown that patients are often inaccurate in predicting future QoL after breast cancer surgery and that mispredictions can be associated with decisional regret.13,14 Thus, as survivorship increases after breast cancer treatment, patients must be appropriately informed regarding expectations for future QoL as they decide between surgical treatment options for breast cancer.
To date, most studies that have evaluated PROs among patients receiving BCT versus mastectomy have been cross-sectional or have only looked at short term trends in PROs.6–11 However, patients with breast cancer may undergo a multitude of adjuvant therapies and endure lingering side effects of the multiple treatment modalities which may affect PROs over time.9 In this study, we sought to (1) assess how receipt of lumpectomy versus mastectomy impacted patients’ abilities to return to their preoperative baseline for PROs and (2) evaluate longitudinal trends in PROs for patients receiving lumpectomy versus mastectomy in the first year after surgery.
PATIENTS AND METHODS
Study Population and Design
This was a prospective cohort study and was deemed exempt after review by the institutional review board (COMIRB# 18–2562). Adult female patients with newly diagnosed stage 0–III breast cancer who were evaluated at an academic breast surgical oncology clinic between June 2019 and May 2024 were eligible to participate in this study. Patients were excluded from the study if they were found to have distant metastases, if they did not undergo surgery at the primary institution, or if they wished to no longer participate.
Survey Administration
Eligible patients were approached by research personnel during their initial multidisciplinary clinic visit and were invited to complete PRO surveys prior to, during, and after treatment for their breast cancer. Surveys were administered via email using the Research Electronic Data Capture (REDCap) platform. Patients reviewed a postcard consent prior to completion of the first survey and completion of the first survey was recognized as providing consent for study enrollment. All enrolled patients were sent automated invitations to complete subsequent PRO surveys at regular intervals. Subjects received survey invitations every 3 months prior to surgery while undergoing neoadjuvant therapies. In the postoperative period, patients received survey invitations at 2 weeks after surgery and then at 3 month intervals through the first year after surgery.
PRO Measures
Each survey incorporated the BREAST-Q™ Breast Cancer module, a validated PRO measurement tool for patients with breast cancer.15 The BREAST-Q™ modules assess three domains of well-being—psychosocial, physical, and sexual—and three domains of satisfaction—satisfaction with breasts, satisfaction with the medical team, and satisfaction with information received. The preoperative modules were utilized for surveys administered at diagnosis and during neoadjuvant treatments. The postoperative module for BCT or mastectomy was included in each survey sent to patients after their initial cancer operation based on the operation they received. The modules were assessed using a Likert scale and responses were converted to an equivalent Rasch transformed scale ranging from 0 to 100 using the directions provided in the BREAST-Q™ guide with higher scores indicating higher levels of well-being or satisfaction. In this study, we focused specifically on four domains: satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being.
Outcomes of Interest
We tabulated the proportion of patients in both the lumpectomy and mastectomy groups who returned to their preoperative baseline at 3, 6, 9, and 12 months after surgery. Return to baseline was defined as a postoperative domain score that was equal to or greater than the domain score from the preoperative module. Patients had to complete both the preoperative module and postoperative module for the given postoperative timepoint to be included in the analysis. In the longitudinal analysis, the scores for each BREAST-Q™ domain for all timepoints within the first year after surgery were compared between patients who received lumpectomy and those who received mastectomy with or without reconstruction.
Demographic and Clinicopathologic Data
Demographic data including age, race, ethnicity, sex, relationship status, employment status, education level, and income level were collected in a questionnaire included with the first survey sent to patients after diagnosis. All demographic data were self-reported. Clinicopathologic data, including cancer stage, operations performed, reconstruction, and adjuvant and neoadjuvant therapies received, were collected through review of the electronic medical records.
Statistical Analysis
Demographic and clinicopathologic factors were compared between the lumpectomy and mastectomy groups using chi squared tests and Fisher’s exact tests for categorical variables, and Wilcoxon Mann–Whitney tests for continuous variables. Linear mixed models were used to estimate the change in PRO scores over time in the mastectomy and lumpectomy groups, which included a random intercept for each subject to account for individual variations in baseline measures. Additionally, an autoregressive (AR) covariance structure was incorporated to model the correlation between observations taken at consecutive time points; this structure assumes that the correlation between measurements decreases as the time lag between them increases. Subgroup analyses were performed for the mastectomy cohort to compare those who had reconstruction with those who did not, those who had unilateral versus bilateral mastectomies, and for flap-based reconstruction to implant-based reconstruction. We first modeled change over time as a straight line in each group, and then used restricted cubic splines to allow for nonlinearities in the pattern of change over time. Models were adjusted for age (which was also modeled with a restricted cubic spline, to allow for nonlinearities in the age-PRO relationships) and receipt of adjuvant therapies, including chemotherapy, radiation, and endocrine therapy. All analyses were performed using SAS version 9.4 (SAS Institute, Inc., Cary, NC, USA). All tests were two-tailed; the threshold for statistical significance was p < 0.05.
RESULTS
A total of 1407 patients were seen by a surgeon in the breast cancer multidisciplinary clinic during the study period. Of these, 489 patients (35%) enrolled in the study and 292 (21%) were included in the final study sample (Fig. 1). Survey response rates at each measured time point over time are shown in Table 1. Survey response rates diminished over time for both the lumpectomy and mastectomy group. Table 2 shows the number of patients who completed the baseline survey and also completed a postoperative survey as well as the number of patients who completed a post-operative survey in the absence of a baseline survey. The former grouping was eligible for the return to baseline analysis, while the latter was not. Both groupings were included in the longitudinal analysis. Demographic and clinicopathologic factors for patients in the study sample for the lumpectomy and mastectomy groups are shown in Table 3. The lumpectomy group was older (median 63 years versus 50 years; p < 0.01), more likely to receive adjuvant radiation and endocrine therapy, and less likely to receive neoadjuvant or adjuvant chemotherapy compared with the mastectomy group. The mastectomy group was more likely to have undergone an axillary lymph node dissection (11.0% versus 2.3%; p < 0.01) and was less likely to have clinical stage 0–I disease (59.2% versus 86.6%; p < 0.01). In total, 77% of mastectomy patients underwent reconstruction; 18.5% of mastectomy patients who underwent mastectomy had flap-based reconstruction while 81.5% had implant-based reconstruction. The lumpectomy and mastectomy groups were similar in terms of race, income, education, and relationship status.
FIG. 1.
Flow diagram showing the process by which patients were included in the study sample. Survey response rates for each timepoint are also listed
TABLE 1.
Survey completion rates for patients in overall cohort as well as the lumpectomy and mastectomy groups
| Overall n (%) N = 347 |
Lumpectomy n (%) N = 203 |
Mastectomy n (%) N = 144 |
|
|---|---|---|---|
|
| |||
| Baseline | 237 (68%) | 138 (68%) | 99 (69%) |
| 3 Months post surgery | 198 (57%) | 119 (59%) | 79 (55%) |
| 6 Months post surgery | 169 (49%) | 95 (47%) | 74 (51%) |
| 9 Months post surgery | 159 (46%) | 90 (44%) | 69 (48%) |
| 12 Months post surgery | 137 (40%) | 80 (39%) | 57 (40%) |
TABLE 2.
Number of responders to PRO surveys at each postoperative time point who did and did not complete the baseline PRO survey
| PRO survey responders both at baseline and at each given time pointa | Percent of baseline survey responders (N = 239) who completed a PRO survey at each given time point (%) | PRO survey responders at each given time point that did not complete the baseline surveya | |
|---|---|---|---|
|
| |||
| Any postop timepoint(s) | 218 | 91 | 53 |
| 3 Months postop | 171 | 72 | 30 |
| 6 Months postop | 155 | 65 | 19 |
| 9 Months postop | 145 | 61 | 19 |
| 12 Months postop | 128 | 54 | 12 |
Responders are those who completed at least one PRO scale at that timepoint
TABLE 3.
Comparison of demographic and clinicopathologic factors between patients who underwent lumpectomy versus mastectomy
| Overall n (%) N = 292 |
Lumpectomy n (%) N = 172 |
Mastectomy n (%) N = 120 |
p-Value | |
|---|---|---|---|---|
|
| ||||
| Age at diagnosis | 59.0 (48.0–66.0) | 63.0 (54.0–69.0) | 50.0 (43.0–59.0) | < 0.01 |
| Race | 0.94 | |||
| Asian | 2.9% (8) | 3.1% (5) | 2.7% (3) | |
| Black or African American | 2.6% (7) | 3.1% (5) | 1.8% (2) | |
| White | 90.8% (248) | 90.0% (144) | 92.0% (104) | |
| Other | 3.7% (10) | 3.8% (6) | 3.5% (4) | |
| Ethnicity | 0.14 | |||
| Hispanic or Latino | 5.6% (15) | 3.9% (6) | 8.0% (9) | |
| Not Hispanic or Latino | 94.4% (252) | 96.1% (149) | 92.0% (103) | |
| Education level | 0.41 | |||
| High school, some college, technical degree | 32.2% (85) | 34.2% (53) | 29.4% (32) | |
| Bachelor’s, Master’s, PhD, advanced degree | 67.8% (179) | 65.8% (102) | 70.6% (77) | |
| Employment status | < 0.01 | |||
| Unemployed, retired, disability | 40.7% (107) | 51.3% (79) | 25.7% (28) | |
| Employed | 59.3% (156) | 48.7% (75) | 74.3% (81) | |
| Body mass index (BMI) | 27.0 (23.4–31.0) | 27.5 (24.0–31.1) | 26.0 (22.8–30.2) | 0.05 |
| Annual household income | 0.06 | |||
| < $90,000 | 46.1% (117) | 51.0% (76) | 39.0% (41) | |
| $90,000+ | 53.9% (137) | 49.0% (73) | 61.0% (64) | |
| Relationship status | 0.20 | |||
| Single, separated, divorced, widow | 29.9% (82) | 32.9% (53) | 25.7% (29) | |
| Married or in a relationship | 70.1% (192) | 67.1% (108) | 74.3% (84) | |
| Clinical stage | < 0.01 | |||
| 0–I | 75.3% (220) | 86.6% (149) | 59.2% (71) | |
| II–IV | 24.7% (72) | 13.4% (23) | 40.8% (49) | |
| Axillary surgery | < 0.01 | |||
| SLND or TAD or none | 94.1% (273) | 97.7% (168) | 89.0% (105) | |
| ALND | 5.9% (17) | 2.3% (4) | 11.0% (13) | |
| Reconstruction | < 0.01 | |||
| Reconstruction | 35.1% (102) | 5.8% (10) | 77.3% (92) | |
| No reconstruction | 64.9% (189) | 94.2% (162) | 22.7% (27) | |
| Mastectomy characteristics | ||||
| Flap-based reconstruction | 18.5% (17) | |||
| Implant-based reconstruction | 81.5% (75) | |||
| Unilateral mastectomy | 29.4% (35) | |||
| Bilateral mastectomy | 70.6% (84) | |||
| Neoadjuvant chemotherapy | < 0.01 | |||
| No | 80.8% (231) | 90.1% (155) | 66.7% (76) | |
| Yes | 19.2%(55) | 9.9% (17) | 33.3% (38) | |
| Adjuvant chemotherapy | < 0.01 | |||
| No | 76.2% (218) | 84.9% (146) | 63.2% (72) | |
| Yes | 23.8% (68) | 15.1% (26) | 36.8% (42) | |
| Adjuvant radiation | < 0.01 | |||
| No | 39.3% (112) | 22.1% (38) | 65.5% (74) | |
| Yes | 60.7% (173) | 77.9% (134) | 34.5% (39) | |
| Endocrine therapy | 0.04 | |||
| No | 20.5% (58) | 16.5% (28) | 26.5% (30) | |
| Yes | 79.5% (225) | 83.5% (142) | 73.5% (83) | |
Bold signifies p-value less than 0.05
Return to Baseline Analysis
At 3 months after surgery, a higher proportion of patients in the lumpectomy group equaled or exceeded their baseline domain score for satisfaction with breasts (62.0% versus 35.5%; p < 0.01), psychosocial well-being (70.7% versus 47.5%; p < 0.01), and sexual well-being (58.6% versus 17.9%; p < 0.01) compared with the mastectomy group. However, a higher proportion of patients in the mastectomy group equaled or exceeded their baseline domain score for physical well-being. Similar trends were seen at 6, 9, and 12 months post surgery, though the proportions returning to or exceeding to baseline scores for physical well-being were not significantly different between the two groups at 9 and 12 months (Table 4).
TABLE 4.
Proportions of patients who returned to their preoperative baseline scores for each BREAST-Q™ domain at 3, 6, 9, and 12 months after surgery
| Lumpectomy % (n) | Mastectomy % (n) | p-Value | |
|---|---|---|---|
|
| |||
| Satisfaction, 3 months | N = 92 | N = 62 | < 0.01 |
| 62.0% (57) | 35.5% (22) | ||
| Psychological, 3 months | N = 82 | N = 59 | < 0.01 |
| 70.7% (58) | 47.5% (28) | ||
| Physical, 3 months | N = 101 | N = 60 | < 0.01 |
| 6.9% (7) | 36.7% (22) | ||
| Sexual, 3 months | N = 70 | N = 56 | < 0.01 |
| 58.6% (41) | 17.9% (10) | ||
| Satisfaction, 6 months | N = 74 | N = 62 | < 0.01 |
| 67.6% (50) | 32.3% (20) | ||
| Psychological, 6 months | N = 69 | N = 60 | 0.08 |
| 63.8% (44) | 48.3% (29) | ||
| Physical, 6 months | N = 82 | N = 62 | < 0.01 |
| 11.0% (9) | 35.5% (22) | ||
| Sexual, 6 months | N = 64 | N = 51 | < 0.01 |
| 51.6% (33) | 15.7% (8) | ||
| Satisfaction, 9 months | N = 70 | N = 49 | < 0.01 |
| 75.7% (53) | 44.9% (22) | ||
| Psychological, 9 months | N = 64 | N =58 | 0.08 |
| 70.3% (45) | 55.2% (32) | ||
| Physical, 9 months | N = 77 | N = 58 | 0.20 |
| 16.9% (13) | 25.9% (15) | ||
| Sexual, 9 months | N = 57 | N = 52 | < 0.01 |
| 66.7% (38) | 19.2% (10) | ||
| Satisfaction, 12 months | N = 64 | N = 40 | 0.03 |
| 64.1% (41) | 42.5% (17) | ||
| Psychological, 12 months | N = 56 | N = 49 | < 0.01 |
| 76.8% (43) | 49.0% (24) | ||
| Physical, 12 months | N = 70 | N = 50 | 0.29 |
| 12.9% (9) | 20.0% (10) | ||
| Sexual, 12 months | N = 54 | N = 41 | < 0.01 |
| 66.7% (36) | 26.8% (11) | ||
Bold signifies p-value less than 0.05
Longitudinal PRO Analysis
After adjusting for age, receipt of adjuvant chemotherapy, radiation therapy, and endocrine therapy, linear models demonstrated that lumpectomy patients demonstrated greater increases in scores over time for satisfaction with breasts (p < 0.01), psychosocial well-being (p = 0.03), and sexual well-being (p < 0.01) compared with patients who underwent mastectomy with reconstruction (Fig. 2). Patients who had mastectomy without reconstruction did not have significantly different trends in these domains over time compared with patients who had mastectomy with reconstruction. There were no differences in trends for any domain among patients who had unilateral versus bilateral mastectomies, nor were there differences in trends for patients who had flap-based reconstruction versus implant-based reconstruction. All groups showed similar declines in physical well-being over time (p = 0.24). The nonlinear models (Fig. 3) similarly demonstrated superior PRO scores over time for the lumpectomy group in satisfaction with breasts (p < 0.01), psychosocial well-being (p < 0.01), and sexual well-being (p < 0.01). However, the mastectomy group had greater scores over time for physical well-being (p = 0.01), predominantly seen at the 3 and 6 month time points.
FIG. 2.
Linear model depicting longitudinal trends in patient reported outcome scores in the first year after lumpectomy versus mastectomy with or without reconstruction. Shading represents the 95% confidence intervals
FIG. 3.
Nonlinear model depicting longitudinal trends in patient reported outcome scores in the first year after lumpectomy versus mastectomy. Shading represents the 95% confidence intervals
DISCUSSION
In this longitudinal cohort study, patients who underwent lumpectomy exhibited greater satisfaction with breasts, psychosocial well-being, and sexual well-being over the first year after surgery compared with patients who underwent mastectomy with reconstruction and mastectomy without reconstruction. Patients who underwent lumpectomy demonstrated more prominent declines in physical well-being scores over time compared with those who underwent mastectomy, and patients who underwent mastectomy were more likely to return to their preoperative level of physical well-being at 3 and 6 months after surgery than patients who underwent lumpectomy.
Several prior studies have used the BREAST-Q™ module to evaluate differences in PROs among patients who underwent BCT versus mastectomy. Swanick et al. reviewed survey responses from 489 female patients aged 67 years or older with nonmetastatic breast cancer, finding that BREAST-Q scores for the psychosocial, sexual, and physical well-being domains tended to be better in patients who underwent lumpectomy rather than mastectomy and in patients receiving less radiation.6 In a cross-sectional study of 2026 women who underwent lumpectomy and 1207 women who underwent mastectomy with implant-based reconstruction, Flanagan et al. reported superior satisfaction with breasts and psychosocial and sexual well-being in the lumpectomy group.7 Similarly, Jay et al. reviewed BREAST-Q outcomes in 161 patients who underwent BCT and 96 patients who underwent mastectomy and found that the lumpectomy group had significantly higher average scores in satisfaction with breasts and psychosocial and sexual well-being.8 More recently, Hanson et al. published data from 315 patients who underwent BCT and 236 patients who underwent mastectomy with reconstruction but without radiation therapy, which showed superior psychosocial and sexual well-being in the BCT group at a median follow up time of 10.3 years.10 Another review comparing PROs in patients who underwent BCT with those who underwent mastectomy with reconstruction also reported higher psychosocial and sexual well-being scores among patients receiving BCT with similar satisfaction with breast and physical well-being.11 Our findings of higher scores for satisfaction with breasts and psychosocial and sexual well-being in the first year after surgery are in line with these previous studies.
Our study is unique in that it follows PROs longitudinally through the first year after surgery. There have been few studies measuring PROs over time in the same cohort of patients with breast cancer. Jagsi et al. used the Functional Assessment of Cancer Therapy (FACT) questionnaire to evaluate PROs in 1450 patients with breast cancer who underwent lumpectomy, mastectomy without reconstruction, and mastectomy with reconstruction at 9 months and 48 months after surgery, finding similar satisfaction with cosmesis and similar changes in social and emotional well-being across time points between the mastectomy and lumpectomy groups.16 Our group has previously published data on short-term trends in PROs, using the BREAST-Q™ module to evaluate trajectories in PROs over the first 6 months after surgery. We found that compared with patients who underwent mastectomy, those who underwent lumpectomy were more likely to equal or exceed their preoperative baseline scores for satisfaction with breasts, psychosocial well-being, and sexual well-being at 3 and 6 months after surgery.9 The present study corroborates those early findings in a larger cohort and suggests that those trends continue to be present at 9 and 12 months after surgery.
One particularly interesting finding in this study was that patients who underwent lumpectomy experienced declines in physical well-being that lasted throughout the 1-year follow up period. Specifically, patients in the lumpectomy group were less likely to return to their preoperative baseline in the earlier timepoints compared to those in the mastectomy group. After controlling for age and receipt of adjuvant chemotherapy, radiation therapy, and endocrine therapy, declines in physical well-being appeared to be similar between the lumpectomy and mastectomy groups across all time periods. Lumpectomy has previously been associated with lower rates of postoperative complications, better scores in the FACT physical well-being domain, lower rates of chronic pain, and less pronounced functional declines when compared with mastectomy.17–20 However, the majority of the abovementioned studies analyzing BREAST-Q™ data did not find lumpectomy to be associated with better physical well-being.7–11 Potentially contributing to these findings are the effects of axillary surgery, radiation therapy, chemotherapy, and endocrine therapy, the receipt of which differed between our lumpectomy and mastectomy cohorts. In fact, axillary lymph node dissection, radiation therapy, chemotherapy, and endocrine therapy have all been associated with declines in physical functioning.21–24 We suspect that differences in treatments received as well as the more advanced age of the lumpectomy group and potentially lower physiologic reserve to tolerate surgical and adjuvant therapies in the lumpectomy group may have contributed to their more pronounced declines in physical well-being. In addition, patients at our institution are not routinely referred for physical therapy or oncologic rehabilitation therapy for lumpectomy alone and are more likely to receive these therapies if they undergo mastectomy. These differences in ancillary supportive service referrals may also contribute to the differences seen in physical well-being. Interventions to curtail the physical effects of breast cancer surgery and adjuvant therapies should be offered to patients early on during the treatment course.
This study has several limitations that must be considered when interpreting the results. First, its design as a cohort study makes it susceptible to selection bias. Additionally, all data were gathered through patients’ survey responses, making this study susceptible to nonresponse bias, which would be expected to increase over time as response rates diminished over the course of the study. This study was performed at a single center which may limit its generalizability to broader populations. Another point worth considering is that the study spanned across the coronavirus 2019 (COVID-19) pandemic period, which may have affected patients’ QoL and may have influenced patients’ decisions on treatment options owing to health system resource limitation. Further, participants within the cohort were overwhelmingly Caucasian, had higher levels of educational attainment, and had higher than the median national income, which may limit the generalizability of our findings to patients of underrepresented races, ethnicities, and socioeconomic statuses. While the demographic makeup of the study institution may have contributed to the homogeneity of respondents, previous work has shown significant variability in survey response rates among different ethnic and socioeconomic groups, which may also have contributed to the lack of diversity in our cohort of respondents.25 Further work building on the findings of this study must incorporate more diverse patient populations so patients from all backgrounds have more accurate information on expectations of future QoL after breast cancer surgery. Additionally, complications and unexpected reoperations were not evaluated in this his study. While major complications are rare, they may affect PROs. Finally, this study focuses on PRO trends in the first year after surgery where many effects of the primary surgery and adjuvant radiation, chemotherapy, and endocrine therapy on PROs may manifest. However, some patients who undergo mastectomy did not undergo their final reconstructive operations within the first year after their oncologic operations and changes in the appearance of breasts as well as adverse effects of adjuvant therapies may not become evident during the period analyzed. Further evaluation of PRO trends beyond the first year after surgery will be a future endeavor of this research group.
CONCLUSIONS
In this analysis of PRO trends over the first year of breast cancer surgery, we found that patients who underwent lumpectomy tended to report better satisfaction with breasts, psychosocial well-being, and sexual well-being than patients who underwent mastectomy. However, lumpectomy was associated with inferior postoperative physical well-being. While further work must be done to corroborate these findings, they may help inform patients with early-stage breast cancer making decisions about their surgical care.
ACKNOWLEDGEMENT
This research was supported in part by the Shared Resource of the Colorado Cancer Center Support Grant P30CA046934 and University of Colorado Department of Surgery Academic Enrichment Fund Seed Grant. Further support for this work was provided by Grant 2020141 from the Doris Duke Charitable Foundation and University of Colorado School of Medicine and the Paul Calabresi Clinical Scholars Award.
Footnotes
Data Presented at: American Society of Breast Surgeons Annual Meeting, Orlando, FL on 10–14 April 2024.
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