Abstract GS6-06: Local therapy and quality of life outcomes in young women with breast cancer

Abstract

Background: Increasing rates of mastectomy, primarily bilateral mastectomy (BMx), have been most dramatic in young women with breast cancer (BC). Impact on long-term quality of life (QOL) is largely unknown. Methods: Between 10/2016-11/2017, we administered the BREAST-Q, a validated patient-reported outcomes measure, to women dx with BC at age ≤40 in a large prospective cohort study. Demographic and treatment information was obtained by surveys and chart review. Mean BREAST-Q scores for each domain (breast satisfaction, physical, psychosocial, and sexual) were compared by surgery types; higher BREAST-Q scores (range: 0-100) indicate better QOL. Linear regression was used to identify predictors of BREAST-Q domain scores. Results: 581 women with stage 0-3 BC completed the BREAST-Q a median of 5.8 years from dx. Median age at dx was 37 (range: 26-40) years; 86% had stage 0, 1 or 2 disease; 28% had breast-conserving surgery (BCS); 72% had mastectomy (Mx), among whom 72% underwent BMx and 89% had reconstruction. Mean BREAST-Q scores (unadjusted) for breast satisfaction, psychosocial, and sexual well-being were lower for patients having unilateral mastectomy (UMx) or BMx compared to BCS; physical function was similar among groups. In multivariate analysis, lower BREAST-Q psychosocial scores were associated with radiation and Mx (UMx or BMx). Lower sexual well-being scores were also associated with Mx. Lower satisfaction with breast scores following radiation were of a clinically significant magnitude (β -8.1 95% CI -11.9- -4.3, p-value 0.03). Lower scores for physical well-being were seen for patients reporting lymphedema and higher for those who had undergone surgery more than 5 years prior. Lower scores across all 4 domains were associated with reported financial distress. BREAST-Q domain mean scores (SD) BMxUMxBCSp-valueBreast satisfaction60.3 (18.9)59.5 (21.3)65.9 (20.7)0.008Physical well-being78.6 (14.9)79.7 (15.1)78.9 (15.5)0.8Psychosocial well-being68.1 (20.8)70.5 (21.2)76.1 (20.5)<0.001Sexual well-being48.6 (21.3)53.2 (21.7)57.5 (18.7)<0.001SD Standard deviation Conclusion: Local therapy in young breast cancer survivors may have a persistent impact on their breast satisfaction, psychosocial, and sexual outcomes, with particular effects from UMx or BMx. Socio-economic stressors also appear to play a role. When counseling young women about their surgical decisions, knowledge of potential long-term QOL impact is of critical importance. Citation Format: Dominici LS, Hu J, King TA, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Warner E, Partridge AH, Rosenberg SM. Local therapy and quality of life outcomes in young women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS6-06.

Update Breast Cancer 2019 Part 1 – Implementation of Study Results of Novel Study Designs in Clinical Practice in Patients with Early Breast Cancer

“…In both investigations, the authors found indications that the long-term quality of life was negatively affected by the radical nature of the surgical approach. In particular in the investigation which had included patients under age 40 (range 26 – 40, mean age 37 years), the psychosocial and sexual well-being was significantly worse in the group of patients who underwent mastectomy 46 , 47 . It is known from other studies that dissatisfaction with the outcome following a mastectomy without reconstruction persists for many years 48 .…”

Does Age Matter? Estimating Risks of Locoregional Recurrence After Breast-conservative Surgery

“…In addition, BCS could offer synergism to Enhanced Recovery After Surgery program, which combines nerve block analgesia, needle wire localization and probe-guided surgery, to allow day surgical management in selected patients (14,(26)(27)(28)(29)(30)(31)(32). BCT is well accepted by women and shows better outcomes for sexual and psycho-social well-being, as well as breast satisfaction compared to unilateral and bilateral Mx (33).…”

Update Mammakarzinom 2019 Teil 1 – Implementierung der Ergebnisse neuer Studienkonzepte beim frühen Mammakarzinom in die klinische Praxis

“…In both investigations, the authors found indications that the long-term quality of life was negatively affected by the radical nature of the surgical approach. In particular in the investigation which had included patients under age 40 (range 26-40, mean age 37 years), the psychosocial and sexual well-being was significantly worse in the group of patients who underwent mastectomy [46,47]. It is known from other studies that dissatisfaction with the outcome following a mastectomy without reconstruction persists for many years [48].…”

“…In this context, reference should be made to the results of two other studies, each with far more than 500 patients and which addressed with the long-term quality of life following breast cancer surgery: the E5103 study [46] which had included all age groups, and another large multicentre study which assessed quality of life (QoL) in patients under age 40 [47]. In both investigations, the authors found indications that the long-term quality of life was negatively affected by the radical nature of the surgical approach.…”