Extensive surgery in young breast cancer survivors tied to poorer QOL outcomes: JAMA

Increasing rates of bilateral mastectomy has been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown.

A study was conducted by Dominici L et. al to examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors.

This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or older enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed during a 1- to 2-year period after the conclusion of the study.

The primary outcome was mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL.

Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain.

The results of the study are as follows:

• A total of 560 women with stage 0 to III breast completed the BREAST-Q within a median of 5.8 years from diagnosis.
• A total of 290 patients (52%) of patients underwent a bilateral mastectomy, 110 patients (20%) underwent a unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy.
• Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy.
• In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction and complex reconstruction (vs autologous) with worse physical well-being.

Thus, the researchers concluded that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.

Reference:

Association of Local Therapy with Quality-of-Life Outcomes in Young Women with Breast Cancer by Dominici, L et. al published in the JAMA Surgery.

doi:10.1001/jamasurg.2021.3758