Self-Compassion in Women After Breast Cancer Surgery: A Concept Analysis Based on Walker and Avant’s Method

Elucidating the Role of Chest Wall Irradiation in ‘Intermediate-risk’ Breast Cancer: the MRC/EORTC SUPREMO Trial

Localising the Tumour Bed in Breast Radiotherapy

Body acceptance in women with breast cancer: A concept analysis using a hybrid model

Objective: To evaluate the quality of life (QoL) of breast cancer patients’ post-surgery, compare conservative, radical, and oncoplastic surgical outcomes, and identify symptoms and treatment-related factors that negatively impact QoL. Methods: This observational, cross-sectional, descriptive study was conducted at the Hospital do Servidor Público Estadual de São Paulo (HSPE) from October 2021 to December 2022. We assessed the QoL of female state public servants presenting in situ or non-metastatic invasive breast cancer who underwent surgical treatment and completed the EORTC QLQ-C30 questionnaire. Inclusion criteria encompassed female patients over 18 years, diagnosed with breast cancer, undergoing surgical treatment, employed as public servants in São Paulo, and actively working at diagnosis. Exclusion criteria included refusal to respond to the questionnaire and metastatic breast cancer at the study's outset or progression within six months of diagnosis. Ethical approval was obtained from the HSPE Research Ethics Committee (CAAE 68337823.4.0000.5463), and all participants signed informed consent forms. Results: The study included 300 patients with a mean age of 56.6 years. Most participants had a partner (55.69%) and higher education (72.15%). The EORTC QLQ-C30 scores indicated a reasonable overall quality of life, with an average score of 70.6. Physical (76.6), social (87.1), and role functioning (78.3) scored high. Most patients did not experience bed confinement, did not need assistance with daily activities, and were able to maintain their leisure activities. Emotional functioning had the lowest score (65.1), indicating some level of tension, irritability, depression, or worry. On the symptom scale, insomnia (33.3), pain (30.0), and fatigue (28.3) were the most prevalent, while nausea and vomiting (5.7), dyspnea (7.2), and diarrhea (8.0) scored low, suggesting little interference with daily activities. There was some financial difficulty due to the physical condition and treatment (15.6). In the QLQ-BR23, the score for side effects was 18.5, indicating few adverse effects from systemic treatments. Concerns about hair loss (35.9), arm symptoms (25.2), and breast symptoms (22.4) were the most affected. Body image acceptance was good (74.9), indicating that most patients did not feel less attractive or feminine. Sexual function scored high (82.5), but sexual satisfaction was lower (57.4), showing that although sexual activity continued, satisfaction was impaired. Patients who underwent conservative surgery had better overall quality of life (73.2) compared to radical (66.7) and oncoplastic surgery (55.2) (p=0.033). Cognitive function was better preserved in conservative surgery (79.5) compared to oncoplastic (56.3) (p=0.045). Social function was also better with conservative surgery (90.7) compared to oncoplastic (70.8) and radical (78.3) (p=0.017). More advanced clinical staging was negatively correlated with quality of life, especially in role functioning (p=0.006), social function (p=0.004), and body image (p=0.002). Patients with triple-negative tumors reported greater limitations in activities, while those with HER-2 expression had better role functioning scores (p=0.094). Neoadjuvant chemotherapy was associated with lower body image satisfaction (60.3 vs. 78.9; p=0.033) and greater concern about hair loss (58.3 vs. 30.1; p=0.014). Adjuvant radiotherapy was associated with better overall quality of life (73.0) and social function (89.3) scores (p=0.007 and p=0.033, respectively), as well as lower pain symptoms (8.5 vs. 25.0; p=0.007). Conclusion: Breast cancer patients demonstrated that while the overall quality of life was reasonable, emotional functioning remained a challenge. Conservative surgery yielded better outcomes in quality of life, cognitive, and social functions compared to radical and oncoplastic surgeries. Advanced clinical staging and triple-negative tumors were linked to greater limitations, whereas HER-2 positive patients showed better role functioning. Neoadjuvant chemotherapy negatively impacted body image and increased concern about hair loss, while adjuvant radiotherapy improved overall quality of life and reduced pain. These findings underscore the need for tailored supportive care to address the emotional and specific functional challenges faced by breast cancer patients. Citation Format: Marcelo Antonini, Andre Mattar, Mylena Scheneider Becale, Arthur Gaia Duarte Peixoto, Denise Joffily Pereira da Costa Pinheiro, Renata Arakelian, Felipe Zerwes, Eduardo de Camargo Millen, Francisco Pimentel Cavalcante, Antônio Luiz Frasson, Fabrício Palermo Brenelli, Odair Ferraro, Reginaldo Guedes Coelho Lopes. Breast Cancer Surgery and Its Quality-of-Life Outcomes: A Study of São Paulo Public Employees [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-03-09.

Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy

Introduction and aim. Recent evidence suggests that inhalation anesthesia (IA) is associated with higher cancer mortality than total intravenous anesthesia (TIVA), possibly due to a modulation of the immune response.The aim of this study was to determine the impact of anesthesia techniques on selected parameters of patient immunity considering the evidence of relationship between the anesthesia methods and immune status and, consequently, the incidence of cancer recurrence.Methods. We performed a meta-analysis of clinical studies published in PubMed, Google Scholar, and Cochrane databases, aimed at assessing the impact of anesthesia on the postoperative immune status of patients undergoing breast cancer (BC) surgery. Five randomized and three observational studies were included (a total of 637 patients, of which 320 (50.2%) in the TIVA group). Data on leukocyte counts, matrix metalloproteinases (MMP) 9 and 3, interleukins (IL) 6 and 10 levels, and neutrophil-lymphocyte index (NLI) values were retrieved.Results. Patients after breast cancer surgery who underwent TIVA had significantly lower white blood cell counts (standardized mean difference (SMD)=–0.32; 95% CI: –0.58 to –0.06; I2=58%, P=0.020) and MMP-9 (SMD=–0.35; 95% CI: –0.67 to –0.03; P=0.030; I2=0%) in the postoperative period compared with patients receiving IA. No significant differences in the levels of MMP-3, IL-6, IL-10, and NLI values were found between the two groups.Conclusion. The patients who underwent breast cancer surgery under TIVA had lower blood leukocyte counts and levels of MMP-9, which is involved in the remodeling of extracellular matrix, compared with those operated on under IA, suggesting that the anesthesia method may have an impact on the immunity of breast cancer patients.

Breast cancer, menopause, and long-term survivorship: critical issues for the 21st century

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

Long-term toxicity of an intraoperative radiotherapy boost using low energy X-rays during breast-conserving surgery

Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

PURPOSE: High deductible health plans (HDHPs) have been shown to delay timing of screening for breast cancer, though the relationship with timing of breast cancer surgery is unknown. The objective of this study was to characterize the association between HDHPs and the timing of surgery following routine mammogram. METHODS: Data from the IBM® MarketScan® Commercial Claims Database from 2007-2016 were queried to identify women who underwent screening mammogram with or without a subsequent breast cancer operation. The quarter of breast cancer screening and surgery were modeled with ordinal logistic regression. Time from screening to surgery (time to surgery, TTS) was evaluated using a Cox proportional hazard function. RESULTS: Among 223,964 patients who had mammograms, 0.7% underwent breast cancer surgery within the following year. For patients in HDHPs compared to low deductible health plans (LDHPs), the odds of screening (odds ratio [OR] 1.146, p<0.001) and surgery (OR 1.120, p<0.001) increased each quarter. HDHP enrollment was not associated with a difference in TTS. Screening in Q3 was associated with shorter TTS compared to screening in Q1 (hazard ratio [HR] 1.070, p<0.001). CONCLUSION: HDHPs were associated with delays in breast cancer screening and surgery, but not with delays in TTS after diagnosis. Interventions to improve breast cancer care, including breast reconstruction, in the HDHP population should concentrate on reducing barriers to timely screening.

Timing of quality of life assessment in cancer clinical trials: fine tuning remains a challenge

The state of HER-2 status

INTRODUCTION Autologous fat grafting (AFG) for the purpose of breast reconstruction presents difficulties during follow-up radiological exams and the oncological potential of grafted fat is uncertain. Coleman et al in 2007 confirmed that, provided a rigorous protocol is respected, the fatty tissue could be transferred under good conditions and would not interfere with mammographic follow-up, although the issue remains controversial about the oncological safety. This study aims to analyze the oncological safety of lipofilling through a meta-analysis of the current literature. METHODS We conducted a meta-analysis to evaluate the oncological safety of AFG after breast cancer (BC) surgery. We reviewed the literature published until 07/05/2020. The outcomes were overall survival (OS), disease free-survival (DFS) and local recurrence (LR). We included RCTs, cohort studies, case-control studies that evaluated women with BC diagnosis who undergone surgery followed by reconstruction with AFG. This review was performed in accordance with the PRISMA guidelines and we searched the electronic databases of Medline, EMBASE and LILACS, using the MeSH terms for AFG and BC. There was no language restriction. Methodological quality was assessed using the Downs and Black instrument and evidence quality by GRADE. We synthesized data using the inverse variance method on the log-HR scale for time-to-event outcomes using RevMan. We assessed the presence of statistical heterogeneity using the Chi2 statistic and we investigated its extension by the use of I2 statistic. RESULTS We identified 624 references. Of these, 16 studies fulfilled our eligibility criteria and were included. Funnel plot analysis revealed no publication bias. There were 8667 patients included and their mean age was 49 years. The breast surgery indications were invasive breast carcinoma (66.1%), carcinoma in situ (18.4%) and prophylactic reasons (15,5%). Ten out of 16 studies described the technique used to perform the AFG as Coleman’s. In 9 out 16 studies there was no difference in adjuvant treatment between groups, two studies do not mention if there was any difference and in 4 studies there were different adjuvant treatments in control and intervention arms. Quality assessment resulted in 11 studies being considered ‘good’, 4 studies were considered ‘fair’ and 1 study was considered poor. The HR could be extracted from four studies and an increase of OS for lipofilling group was detected with high heterogeneity (HR 0.47, 95% CI 0.32 to 0.7, p=0.0002, 2331 patients, I2= 84%, high certainty evidence). Funnel plot analysis indicated a high risk of publication bias from one study, Krastev et al, which included 587 patients. The analysis excluding this article found no difference in OS between lipofilling group and control and publication bias was not detected (HR 0.9, 95% CI 0.53 to 1.54, p=0.71, 1744 patients, I2= 58%, high certainty evidence). The HR for DFS could be extracted from six studies and no difference was found between lipofilling group and control (HR 1.01, 95% CI 0.73 to 1.38, p=0.96, 2755 patients, I2= 0%, high certainty evidence). The HR for LR could be extracted from ten studies and no difference was found between lipofilling group and control (HR 0.86, 95% CI 0.66 to 1.12, p=0.43,6839 patients, I2= 1%, moderate certainty evidence). Funnel plot analysis indicated a publication bias from one study (Petit et al) that included only DCIS tumors. The analysis excluding this article did not demonstrate difference in results. (HR 0.8, 95% CI 0.61 to 1.05, p=0.94, 6662 patients, I2= 0%, moderate certainty evidence) CONCLUSION Based on published data, AFG is a safe technique of breast reconstruction for patients that undergone BC surgery. According to our findings, AFG did not affect OS, DFS or LR. These data have moderate to high certainty and additional studies probably will not change the current evidence. Citation Format: Rodrigo Goncalves, Bruna S Mota, Bruno Sobreiro-Lima, Marcos D Ricci, José M Soares, Jr, Edmund C Baracat, José R Filassi. The oncological safety of lipofilling after breast cancer surgery: A meta-analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-22.

This study aimed to evaluate regional disparities in surgical approaches and patient-reported outcomes (PROs) among early breast cancer patients in urban and rural areas of Nagasaki Prefecture, Japan. We retrospectively analyzed clinicopathological data from 1032 patients (urban: 818; rural: 214) who underwent breast cancer surgery between 2014 and 2021. PROs were assessed using the BREAST-Q survey conducted from October 2022 to June 2024 among patients; a total of 76 patients (urban n = 40; rural n = 36) completed the questionnaire. Total mastectomy was significantly more frequent in rural facilities (66.8%) than in urban ones (49.9%). Importantly, patients undergoing breast‑conserving surgery (BCS), regardless of geographic location, reported significantly better quality‑of‑life outcomes (higher satisfaction with body image, psychological well‑being, and sexual well‑being). Geographic disparities in access to specialized surgeons and radiotherapy infrastructure may influence surgical strategies, which in turn impact PROs. These results underscore the need to address logistical barriers, surgeon availability, and rural healthcare infrastructure to ensure equitable access to BCS and improve PROs and overall quality of life.