Background: For older women with breast cancer, local therapy options may include (1) lumpectomy followed by whole breast irradiation (Lump+WBI), (2) lumpectomy followed by brachytherapy (Lump+Brachy), (3) lumpectomy followed by endocrine therapy alone without radiation (Lump alone), (4) mastectomy without radiation (Mast alone), or (5) mastectomy followed by radiation (Mast+RT). For many patients, several of these options are acceptable based on current guidelines, but little is known about the impact of treatment choice on long-term cosmetic outcomes. We surveyed a population-based cohort of older breast cancer survivors treated with 1 of these 5 options to assess patient satisfaction with cosmetic outcome.
Methods: We used nationally comprehensive Medicare claims to identify women age ≥67 diagnosed with non-metastatic breast cancer in 2009, treated with 1 of these 5 treatment options, and still alive in 2015. From this cohort, 1650 patients (330 patients per local therapy) were randomly selected. Of these, 397 opted out, and the remaining 1253 potential participants were mailed a survey that included the CanSORT Satisfaction with Breast Cosmetic Outcomes instrument (5-point scale, higher score indicates greater satisfaction) and the Breast-Q Satisfaction with Breast instrument (0-100 Rasch transformed score, higher score indicates greater satisfaction). Multivariable linear regression models were used to assess the association of local therapy with each outcome, adjusting for age, race, comorbidity, chemotherapy, patient-reported BMI, bra cup size, smoking, income, and education. Spearman's correlation assessed the relationship between the 2 outcomes. All analyses incorporated sample and response weights.
Results: We received completed surveys from 498 women (30% response rate). The median age was 73 years (range, 67-87 years). The interval from diagnosis to survey was 6 years for all patients. Among patients with evaluable CanSORT responses (n=439), the weighted mean score by treatment group was 3.64 for Lump+WBI, 4.01 for Lump+Brachy, 3.83 for Lump alone, 3.28 for Mast alone, and 3.25 for Mast+RT. In multivariable analysis with Lump+WBI as the referent, the adjusted CanSORT mean score was 0.37 points higher for Lump+Brachy (P=0.009), 0.35 points lower for Mast alone (P=0.035), and 0.33 points lower for Mast+RT (P=0.048). Among patients with evaluable Breast-Q Satisfaction responses (n=418), the weighted mean score by treatment group was 60.9 for Lump+WBI, 68.8 for Lump+Brachy, 66.7 for Lump alone, 58.8 for Mast alone, and 52.0 for Mast+RT. In multivariable analysis with Lump+WBI as the referent, the adjusted Breast-Q Satisfaction score was 7.4 points higher for Lump+Brachy (P=0.03) and 7.8 points lower for Mast+RT (P=0.04). Higher comorbidity predicted worse cosmetic outcome in both models; no other variables were associated with both outcomes. The 2 outcomes were highly correlated (Spearman's coefficient=0.8, P<0.0001).
Conclusion: In this nationally representative cohort, satisfaction with cosmetic outcome (as measured by 2 distinct instruments) was higher for patients treated with Lump+Brachy and lower for those treated with Mast+RT compared to Lump+WBI. These results may be used to inform patient treatment decisions.
Citation Format: Swanick CW, Lei X, Xu Y, Shen Y, Goodwin NA, Giordano SH, Hunt KK, Jagsi R, Shaitelman S, Peterson SK, Smith BD. Patient-reported cosmetic outcomes in older breast cancer survivors: A population-based survey study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-05.