Assessing Outcomes After Breast Surgery: Patient and Clinician Reported Outcomes

Abstract

Background: Survival has significantly improved in women diagnosed with breast cancer, and as a result, it has become increasingly important to assess the psychological outcomes from the patient’s perspective. Interpreting the outcome based on the opinion of the operating surgeons may not reflect the opinions of the patient. The aim of this study was to assess clinician and patient reported outcomes of breast surgery at routine follow-up. Methods: Consecutive patients previously treated for breast cancer attending routine follow-up breast clinic over a period of 5 weeks were invited to participate. Patients were first seen by a clinician for review (four breast surgeons and one clinical nurse specialist), and cosmetic outcome was assessed using the Harris Harvard scale. Patient reported outcomes were measured using the Hopwood body image scale 10-item questionnaire. Results: Of 105 patients, complete data were available for 84 patients. All patients were female with a median age of 65 years (range 32 - 83 years). Wide local excisions accounted for 54% of all surgeries (n = 45), mastectomies 26% (n = 22) and mastectomy with reconstruction 20% (n = 17). Patients’ scores ranged from 0 to 30 with a median score of 1; 9% of patients had a score of > 10. Clinician rating was “excellent” for 37%, 34% as “very good”, 22% as “good” and 5.9% as “poor”. There was a weak correlation of patient scores to clinician score (Spearman rho: 0.219; 95% CI: 0.005 - 0.414; P = 0.045). Conclusions: With standard breast surgery, the majority of patients seen at follow-up clinics were satisfied with their cosmetic outcome, with the most favorable outcomes in patients who had undergone breast conservation, with mastectomy and reconstruction yielding the poorest results. Patient reported outcomes are not reflected in the clinician assessment of cosmesis. J Curr Surg. 2016;6(2):46-51 doi: http://dx.doi.org/10.14740/jcs303w