Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

M C T Batenburg,M Sier,M Sier,T Van Dalen,A Witkamp,A Braakenburg,A Doeksen,E J P Schoenmaeckers,C H Van Gils,W Maarse,H J G D Van Den Bongard,M L Gregorowitsch,H M Verkooijen,D A Young-Afat

doi:10.1007/s10549-019-05470-y

Abstract

PurposeTo evaluate patient-reported cosmetic satisfaction in women treated with radiation therapy for breast cancer and to determine the association between dissatisfaction and quality of life (QoL) and depression.MethodsWithin the prospective UMBRELLA breast cancer cohort, all patients ≥ 1 year after breast conserving treatment or mastectomy with immediate reconstruction were selected. Self-reported cosmetic satisfaction was measured on a 5-point Likert scale. QoL, social functioning, and emotional functioning were measured using EORTC QLQ-C30 and BR23 at 1, 2, and 3 years after inclusion. Mixed model analysis was performed to assess the difference in different domains of QoL between patients with good versus poor self-reported cosmetic satisfaction over time after adjustment for potential confounders. Depression scores were collected by means of the HADS-NL questionnaire. Chi-square test or Fisher's exact test was used to assess the difference in proportions of HADS score ≥ 8, indicating increased depression risk, between satisfied and dissatisfied patients.Results808 patients were selected for analysis. Respectively one, two, and three years after surgery, 8% (63/808), 7% (45/626), and 8% (31/409) of patients were dissatisfied with their cosmetic outcome. Poor patient-reported cosmetic satisfaction was independently associated with impaired QoL, body image, and lower emotional and social functioning. Scores ≥ 8 on the HADS depression subscale were significantly more common in dissatisfied patients.ConclusionsDissatisfaction with cosmetic outcome was low after breast cancer surgery followed by radiation therapy during 3 years follow-up. Knowing the association between dissatisfaction with cosmetic outcome and QoL and depression could help to improve the preoperative counseling of breast cancer patients.

Highlights

Due to the rising incidence of breast cancer, and the improved survival rates, the number of women living with the consequences of breast cancer and breast cancer treatment is growing [1]
The aim of this study was to evaluate the prevalence of poor patient-reported cosmetic satisfaction up to 3 years following breast cancer treatment, to assess the determinants associated with poor cosmetic outcome, and to evaluate the association of poor cosmetic satisfaction with social functioning, emotional functioning, body image, and depression
425 patients had a follow-up < 12 months, 292 patients had no clinical data available, 85 patients were treated with mastectomy without reconstruction, and 530 patients did not respond to the cosmetic questionnaire at 12 months

Summary

Introduction

Due to the rising incidence of breast cancer, and the improved survival rates, the number of women living with the consequences of breast cancer and breast cancer treatment is growing [1]. Cosmetic satisfaction and quality of life (QoL) after breast cancer treatment are increasingly being recognized as important. The majority of breast cancer patients can be treated with breast-conserving therapy, a combination of breast-conserving surgery and breast irradiation [3, 4]. The interest in oncoplastic and reconstructive surgery is rising, leading to improved cosmetic results and higher expectations in patients. The long-term degree of self-reported cosmetic satisfaction with modern treatments and how this affects QoL is yet unclear

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