In this longitudinal study of QOL in rectal cancer patients with a temporary stoma, Global QOL was good despite significant stoma-related difficulties. Use of alternative research methodology is necessary to provide insight into why this contradiction exists.

A temporary ileostomy represents significant difficulties for patients with rectal cancer. However, because of response shift, these difficulties may not be perceived as important to overall quality of life when considered within the context of the cancer experience. Our results can inform preoperative consultations with patients who have rectal cancer to assist in aligning patient expectations of what life with a temporary ileostomy may be like.

Background Re-excision rates in patients undergoing breast-conserving surgery (BCS) for early-stage invasive breast cancer are highly variable. The Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) published consensus guidelines to help standardize practice. We sought to determine re-excision rates before and after guideline adoption at our institution. Methods We identified patients with stage I or II invasive breast cancer initially treated with BCS between 06/01/2013–10/31/2014. Margins were defined as positive (tumor on ink), close (≤1 mm), or negative (>1 mm), and were recorded for both invasive cancer and ductal carcinoma in situ (DCIS) components. Re-excision rates were quantified, characteristics were compared between groups, and multivariable logistic regression was performed. Results 1205 patients were identified; 504 pre-, and 701 post-guideline adoption (01/01/2014). Clinical and pathologic characteristics were similar between time periods. Re-excision rates significantly declined from 21.4% to 15.1% (p=0.006) after guideline adoption. A multivariable model identified extensive intraductal component (odds ratio (OR)=2.5,95% CI 1.2–5.2), multifocality (OR=2.0, 1.2–3.6), positive (OR=844.4, 226.3–5562.5) and close (OR=38.3, 21.5–71.8) DCIS margin, positive (OR=174.2, 66.2–530.0) and close (OR=6.4, 3.0–13.6) invasive margin, and time period (OR=0.5, 0.3–0.9 for post- versus pre-) as independently associated with re-excision. Conclusion Overall re-excision rates declined significantly after guideline adoption. Close invasive margins were associated with higher rates of re-excision than negative invasive margins in both time periods; however, the effect diminished in the post-guideline adoption period. Thus we expect continued decline in re-excision rates as adherence to guidelines becomes more uniform.

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Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery-specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach’s α coefficients (≥0.78) and item-total correlations (range of means, 0.65–0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.