Abstract: The Impact of Delaying Breast Reconstruction on Patient Expectations and Health Related Quality of Life: An Analysis Using the Breast-Q

Abstract

BACKGROUND: An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and pre-operative health-related quality of life vary with time since breast cancer diagnosis. METHODS: Women consulting for breast reconstruction to a single surgeon’s practice over a thirteen-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and pre-operative reconstruction modules. A retrospective chart review then performed on eligible patients, and patient demographics, cancer-related factors, and co-morbidities, were collected. Scores were transformed using the Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since diagnosis. RESULTS: Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (33–79) and a mean BMI of 28 ± 6 (19–49). Most patients were treated by mastectomy (58%), or lumpectomy (23%). At the time of retrospective review, 29 patients (43%) had undergone reconstruction, most of which were delayed (59%). The mean latency from diagnosis to reconstruction was 685 ± 867 days (range: 28–3322 days). Latency from diagnosis to reconstruction was associated with greater expectation of pain (β=0.5; SE=0.005; 95% CI: 0.003 – 0.027; p<0.05), and slower expectation for recovery (β= -0.5; SE=0.004; 95% CI: -0.021 – -0.001; p<0.05). Latency from diagnosis to reconstruction was associated with increased pre-operative psychosocial wellbeing (β =0.578;SE 0.009; CI: 0.002 –0.046; p<0.05). CONCLUSION: Delaying breast reconstruction may negatively impact patient expectations of post-operative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the pre-operative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.