by Kouwenberg, Casimir A. E.; de Ligt, Kelly M.; Kranenburg,
Leonieke W.; Rakhorst, Hinne; de Leeuw, Daniëlle; Siesling, Sabine; Busschbach,
Jan J.; Mureau, Marc A. M.
Plastic and
Reconstructive Surgery: July 2020 -
Volume 146 - Issue 1 - p 1-13
Background:
Differences in quality-of-life outcomes after different
surgical breast cancer treatment options, including breast reconstruction, are
relevant for counseling individual patients in clinical decision-making, and
for (societal) evaluations such as cost-effectiveness analyses. However,
current literature shows contradictory results, because of use of different
patient-reported outcome measures and study designs with limited patient
numbers. The authors set out to improve this evidence using patient-reported
outcome measures in a large, cross-sectional study for different surgical
breast cancer treatment options.
Methods:
Quality of life was assessed through the EQ-5D-5L, European
Organization for Research and Treatment of Cancer Quality of Life
Questionnaires C30 and BR23, and the BREAST-Q. Patients with different
treatments were compared after propensity-weighted adjustment of pretreatment
differences. The EQ-5D was used to value the effect of surgical complications.
Results:
A total of 1871 breast cancer patients participated
(breast-conserving surgery, n = 615; mastectomy, n = 507; autologous
reconstruction, n = 330; and implant-based reconstruction, n = 419). Mastectomy
patients reported the lowest EQ-5D score (mastectomy, 0.805, breast-conserving
surgery, 0.844; autologous reconstruction, 0.849; and implant-based reconstruction,
0.850) and functioning scores of the C30 questionnaire. On the BREAST-Q,
autologous reconstruction patients had higher mean Satisfaction with Outcome,
Satisfaction with Breasts, and Sexual Well-being scores than implant-based
reconstruction patients. Complications in autologous reconstruction patients
resulted in a substantially lower quality of life than in implant-based
reconstruction patients.
Conclusions:
This study shows the added value of breast conservation and
reconstruction compared with mastectomy; however, differences among
breast-conserving surgery, implant-based reconstruction, and autologous breast
reconstruction were subtle. Complications resulted in poorer health-related
quality of life.
