Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study

Howes, Benjamin H.L.; Watson, David I.; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R.

doi:10.1016/j.bjps.2016.06.004

Cited by 164 publications

(136 citation statements)

References 22 publications

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“…Recent studies that collected patient-reported outcomes (PROs) using a wellvalidated, breast surgery-specific instrument (BREAST-Q) 14 demonstrate that breast reconstruction can improve women's satisfaction as well as their psychosocial, physical, and sexual well-being after mastectomy. [15][16][17] In summary, we agree with the consensus statement that CPM should not be routinely performed in the absence of evidence for a survival benefit. But mortality is not the only oncologic outcome that concerns women.…”

supporting

confidence: 52%

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Nass

Nekhlyudov

2017

Ann Surg Oncol

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The increasing rate of contralateral prophylactic mastectomy (CPM) led the American Society of Breast Surgeons (ASBrS) to issue an evidence-based consensus statement on CPM, as well as a discussion guide that health care providers can use to facilitate shared decision making with patients considering CPM for unilateral breast cancer. This article suggests several ways to improve the discussion guide by eliciting patient values and preferences and by providing more current, detailed, and balanced information about the potential risks and benefits of CPM.We commend the American Society of Breast Surgeons (ASBrS) for addressing the complex issue of contralateral prophylactic mastectomy (CPM) with a thorough review of the data and a well-balanced consensus statement. 1 We are concerned, however, that the discussion guide for shared decision making does not achieve the authors' stated goal of considering ''the patient's preferences and values and an informed discussion of the risks and benefits of CPM.'' 2 None of the talking points guide the provider in eliciting a patient's preferences and values. Also, only one talking point includes a potential benefit of CPM (that women who undergo CPM will not need mammograms or routine breast imaging for cancer screening after surgery), whereas the remaining talking points focus on the harms and limitations. Overall, the selection and framing of many of the discussion points are intended to discourage CPM (a stated goal) rather than provide a neutral overview of the individualized potential risks and benefits of CPM.Shared decision making has been defined as a collaborative process that allows patients and their health care providers to make well-informed decisions together with the goal of achieving outcomes that matter most to the patient.3 Well-designed patient decision aids have been shown to enhance patient knowledge and improve the quality of these decisions, including decisions about breast cancer surgery.4,5 A systematic Cochrane Review found that compared with standard care, patient decision aids can enhance patient understanding, including substantial improvement of perceived personal risk, and lead to a better match between values and choices, with no or minimal effect on anxiety, depression, regret, consultation length, or health-related quality of life. 6The International Patient Decision Aids Standards (IPDAS) Collaboration has established a framework for improving the content, development, implementation, and evaluation of patient decision aids, including checklists, tools for evaluation, and minimal standards. 7,8 Their framework calls for a systematic development process using up-to-date evidence, balancing presentation of information and options, clarifying values and preferences, and measuring effectiveness.We encourage the ASBrS to facilitate shared decision making by engaging a multidisciplinary group of experts and applying the IPDAS framework to strengthen and evaluate their discussion guide. We also suggest specific ways to improve several poin...

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supporting

confidence: 52%

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Nass

Nekhlyudov

2017

Ann Surg Oncol

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“…In one of the earliest studies using the BREAST-Q to examine the differences in PROs between women undergoing mastectomy alone versus reconstruction, Eltahir et al demonstrated lower BREAST-Q scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being in women after mastectomy alone versus mastectomy with reconstruction (23). These findings have been replicated in multiple subsequent studies (19, 20, 24, 25), including a prospective study by Chao et al that demonstrated lower Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being Chest in patients undergoing mastectomy alone versus mastectomy with reconstruction (26). While BREAST-Q outcomes following BCT are not as well established, Satisfaction with Breasts scores after BCT with various incision techniques have been reported, along with findings of higher scores associated with lower quantities of resected tissue and scores associated with BCT lower than reconstruction yet higher than mastectomy alone (20, 27-29).…”

Section: Discussionmentioning

confidence: 73%

“…To compare outcomes in patients after mastectomy, a recent study by Ng et al reporting on 79 post-mastectomy patients was selected (19). To compare findings after BCT, a study by Howes et al describing post-operative findings at a mean post-operative time of 2.4 years after BCT (n=97) was selected (20). Data from the Mastectomy Reconstruction Outcomes Consortium (MROC) Study was selected for reconstruction patients.…”

Section: Methodsmentioning

confidence: 99%

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

Mundy

Homa

Klassen

et al. 2017

Plastic &Amp; Reconstructive Surgery

164

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Background The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation. Methods Participants were recruited via the Army of Women, an online community of women (with and without breast cancer), to complete mastectomy, breast conserving therapy (BCT), and reconstruction pre-operative BREAST-Q scales. Inclusion criteria were women aged ≥18 years without a prior history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings. Results The BREAST-Q was completed by 1,201 women. Mean age was 54 ±13 years, mean body mass index (BMI) 26 ±6, and 38% (n=455) had a bra cup ≥D. Mean scores for BREAST-Q scales (±standard deviation) were as follows: Satisfaction with Breasts (58 ±18), Psychosocial Well-being (71 ±18), Sexual Well-being (56 ±18), Physical Well-being-Chest (93 ±11), and Physical Well-being-Abdomen (78 ±20). Women with BMI ≥30, cup size ≥D, age <40, and income <$40,000/year reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts were higher after autologous reconstruction and lower after mastectomy, Sexual Well-being scores were lower after mastectomy and BCT, and Physical Well-being Chest scores were lower after mastectomy, BCT and reconstruction. Conclusions These are the first published normative scores for the BREAST-Q breast cancer modules, and provide a clinical reference point for the interpretation of data.

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“…As recognition of the genetic component of familial breast cancer grows and genetic testing has become more available, rates of bilateral prophylactic mastectomy and contralateral prophylactic mastectomy have increased in high‐risk patients9 10. Furthermore, a trend has also been reported for women who are eligible for breast‐conserving surgery to opt for mastectomy3 11, 12, 13 and contralateral prophylactic mastectomy in the unaffected breast13, 14, 15, 16, 17, despite a lack of evidence of a survival advantage for this approach in the absence of a known genetic mutation.…”

Section: Introductionmentioning

confidence: 99%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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BackgroundBreast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population.MethodsData were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy.ResultsOf 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early‐stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy.ConclusionBreast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant‐based approaches.

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Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study

Cited by 164 publications

References 22 publications

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

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