Long Term QOL of Breast Conservation Vs Mastectomy Reconstruction in Breast Cancer Patients

Despite marked differences in these treatment strategies, little is known about their association with long-term quality of life (QOL). Therefore, Dr Summer E. Hanson and his team conducted a study to evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-term QOL.

In this comparative effectiveness research study, the researchers used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. They compared breast-conserving surgery with RT or mastectomy and reconstruction without RT. The major outcome assessed was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. They also assessed for BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, which was measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. They further used multivariable linear regression models with weights for treatment, age, race and ethnicity to test associations of the exposure with outcomes.

Key findings of the study:

• Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years).
• Upon multivariable analysis, the researchers found no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71) or physical well-being (effect size, –1.80).
• However, they found that the psychosocial well-being (effect size, –8.61) and sexual well-being (effect size, –10.68) were significantly worse with mastectomy and reconstruction without RT.
• They noted that the health utility (effect size, –0.003) and decisional regret (effect size, 1.32) did not differ by treatment group.

The authors concluded, " The findings support the equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer."

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DOI:10.1001/jamasurg.2022.0631