Psychosocial Well-being Scores Research Articles

Impact of Mastectomy Flap Necrosis on Patient-Reported Quality-of-Life Measures After Nipple-Sparing Mastectomy: A Preliminary Analysis.

Mastectomy skin flap necrosis (SFN) is common following nipple-sparing mastectomy (NSM), but studies on its quality-of-life (QOL) impact are limited. We examined patient-reported QOL and satisfaction after NSM with/without SFN utilizing the BREAST-Q patient-reported outcome measure (PROM) survey. Patients undergoing NSM between April 2018 and July 2021 at our institution were examined; the BREAST-Q PROM was administered preoperatively, and at 6 months and 1 year postoperatively. SFN extent/severity was documented at 2-3 weeks postoperatively; QOL and satisfaction domains were compared between patients with/without SFN. A total of 573 NSMs in 333 patients were included, and 135 breasts in 82 patients developed SFN (24% superficial, 56% partial thickness, 16% full thickness). Patients with SFN reported significantly lower scores in the satisfaction with breasts (p = 0.032) and psychosocial QOL domains (p = 0.009) at 6 months versus those without SFN, with scores returning to baseline at 1 year in both domains. In the "physical well-being-of-the-chest" domain, there was an overall decline in scores among all patients; however, there were no significant differences at any time point between patients with or without SFN. Sexual well-being scores declined for patients with SFN compared with those without at 6 months and also at 1 year, but this did not reach significance (p = 0.13, p = 0.2, respectively). Patients undergoing NSM who developed SFN reported significantly lower satisfaction and psychosocial well-being scores at 6 months, which returned to baseline by 1 year. Physical well-being of the chest significantly declines after NSM regardless of SFN. Future studies with larger sample sizes and longer follow-up are needed to determine SFN's impact on long-term QOL.

Patient-reported outcomes and quality of life after breast-conserving surgery, mastectomy, and breast reconstruction assessed using the BREAST-Q questionnaire.

Breast-conserving surgery is the preferred treatment for breast cancer; however, its associated risk of local recurrence is higher than that of mastectomy. We performed a comparative analysis of four patient-reported outcomes, psychosocial well-being, sexual well-being, breast satisfaction, and physical well-being of the chest, and quality of life after three surgical approaches, breast-conserving therapy (BCT), mastectomy alone, and mastectomy with breast reconstruction, for breast cancer treatment. A cross-sectional survey using the BREAST-Q questionnaire and including patients who had undergone breast surgery at least 1year prior to survey completion was performed. The analysis included 1035 patients (mean age, 55.0 ± 9.1years) who underwent breast reconstruction, 116 patients (mean age, 63.6 ± 12.2years) who underwent mastectomy, and 64 patients (mean age, 60.8 ± 12.2years) who underwent BCT. Patients who underwent reconstruction had significantly higher psychosocial well-being scores (62.8 ± 18.4) than those who underwent BCT (57.0 ± 23.6) and mastectomy (50.8 ± 16.8) (p < 0.01). However, significant differences in self-acceptance scores among all patients were not observed. Regarding sexual well-being and breast satisfaction, patients who underwent mastectomy had significantly lower scores (29.9 ± 18.7 and 41.8 ± 17.7, respectively) than those who underwent BCT (45.8 ± 26.6 and 58.3 ± 17.5, respectively) and reconstruction (46.4 ± 20.3 and 58.8 ± 15.4, respectively) (p < 0.01). Physical well-being of the chest scores were not significantly different among all patients (p = 0.14). Symptoms after mastectomy included chest muscle pain and arm movement impairment. Breast pain was a notable symptom after BCT. The study findings provide valuable insights regarding patient-reported outcomes, highlight the potential benefits of breast reconstruction, and emphasize the importance of patients' preferences.

Long-Term Patient-Reported Outcomes Comparing Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery: A Propensity Score-Matched Analysis.

Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q. Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively. A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being. Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.

Abstract P6-05-58: Comparing Patient-Reported Outcomes for Same-day Discharge and Inpatient Admission After Mastectomy

Abstract Background: Same-day discharge after mastectomy has been demonstrated to be safe in appropriately selected candidates. However, the association between same-day discharge after mastectomy and quality of life (QOL) is unclear. Patient-reported outcome (PRO) measures represent important indicators of QOL among patients undergoing treatment for breast cancer. In this study, we aimed to evaluate the effect of same-day discharge after mastectomy on PROs. Methods: We performed a retrospective review of a prospectively collected, longitudinal PRO registry of female breast cancer patients treated at an academic breast center between June 2019 and June 2022. Patients were invited to complete the BREAST-Q module, a validated PRO questionnaire measuring QOL domains such as psychosocial wellbeing, physical wellbeing, satisfaction with their surgeon, and satisfaction with their medical team. Preoperative and 2-week postoperative questionnaire responses were analyzed in this study. Patients who had a mastectomy with or without reconstruction were included in this analysis. Those who underwent immediate reconstruction with autologous tissue were excluded as these operations are not conducive to same-day discharge. Patients were divided into two groups: the first was discharged on the date of surgery while the second was admitted to the hospital for a minimum of one night. Clinical and demographic factors were collected from a review of the electronic medical record. The primary endpoints were mean satisfaction scores as well as differences between postoperative and preoperative scores for the psychosocial and physical wellbeing domains. T-tests were used to evaluate differences between groups. A multiple regression model was fit to adjust for the effects of relevant clinical and demographic factors. Results: A total of 104 patients within the registry underwent mastectomy during the study period and were offered questionnaires. Of these, 58 completed both the preoperative and 2-week postoperative questionnaire (56% response rate); 20 (34%) in the same-day discharge group and 38 (66%) in the inpatient admission group. The groups were similar in age, stage, American Society of Anesthesiologists’ classification group, body mass index, frequency of unplanned readmission or reoperation, and receipt of bilateral mastectomy, axillary lymph node dissection, post-mastectomy reconstruction, and neoadjuvant chemotherapy. Mean patient satisfaction scores and mean changes in psychosocial and physical wellbeing scores were similar between the groups 2 weeks after surgery (Table 1). After controlling for age, type of reconstructive operation, receipt of unplanned reoperation, and preoperative score, same-day discharge did not have a significant effect on satisfaction with the surgeon (Beta=-4.3, p=0.37), satisfaction with the medical team (Beta=0.2, p=0.97), physical wellbeing score (Beta=-0.1, p=0.99), or psychosocial wellbeing score (Beta=8.0, p=0.15). Conclusions: Patients who are discharged from the hospital on the same day of a mastectomy display similar levels of satisfaction with their care team and similar short-term trends in physical and psychosocial wellbeing compared to those who are admitted to the hospital. While further data are being accrued, these early results suggest patients tolerate same-day discharge after mastectomy well. Table 1 Patient-reported outcomes at 2 weeks after mastectomy for patients discharged on the date of surgery compared to those admitted inpatient Citation Format: Sudheer Vemuru, Kathryn Colborn, Laura Leonard, Victoria Huynh, Christodoulos Kaoutzanis, Justin Cohen, David Mathes, Nicole Christian, Gretchen M. Ahrendt, Christine M. Fisher, Simon Kim, Sarah Tevis. Comparing Patient-Reported Outcomes for Same-day Discharge and Inpatient Admission After Mastectomy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-58.

Abstract B020: Does surgical procedure influence psychosocial outcomes after treatment in women with ductal carcinoma in situ?

Abstract Objective: Rates of bilateral mastectomy are increasing in women with ductal carcinoma in situ (DCIS). We aim to characterize the trajectory of psychosocial outcomes after surgery in women with DCIS. Methods: We have been prospectively collecting psychosocial data on women receiving surgery for stage 0-III breast cancer at University Health Network in Toronto, Ontario, Canada since 2009. We queried our prospective database to identify all women receiving surgery for DCIS between May 2009 and January 2020. Women completed validated psychosocial questionnaires (e.g. BREAST-Q, Impact of Event Scale, Hospital Anxiety &amp; Depression Scale) pre-operatively, and at 6 and 12 months following surgery. We analyzed the change in psychosocial scores between three surgical procedures (breast-conserving therapy, unilateral mastectomy and bilateral mastectomy) using linear mixed models, controlling for age and sociodemographic factors (e.g. ethnicity, education level, income and marital status). P values &amp;lt; .05 were significant. Results: 89 women with DCIS were identified, with a mean age of 52.4 ± 10.3 years. By surgical procedure, 7 women underwent breast-conserving therapy (8%), 46 underwent unilateral mastectomy (52%) and 36 underwent bilateral mastectomy (40%). Breast satisfaction (-8, P = .03) and sexual well-being (-10, P = .02) scores decreased over time but was not influenced by surgical procedure. Younger women had worse psychosocial well-being scores (-0.5/year, P = .02), with no impact of surgical procedure. There was a significant interaction between surgical procedure and time for chest physical well-being scores (P = .04); women having breast-conserving therapy had better chest physical well-being scores compared with both unilateral and bilateral mastectomy (with no difference between mastectomy groups). Unemployed women had worse chest physical well-being scores (-9, P = .04). There was a significant interaction between procedure and time for distress scores (P = .02); women having unilateral or bilateral mastectomy had higher distress scores before surgery but at 12 months, there was no difference between surgical procedures. Women with a higher annual income (≥80,000$) had higher breast satisfaction (+10, P = .03), psychosocial well-being (+14, P = .004), and sexual well-being (+12, P = .02), and lower distress (-12, P = .004 ) scores than women earning less than 80,000$ per year. There was a significant interaction (P = .01) between procedure and time for anxiety scores; while all surgical groups had mild anxiety scores at baseline, the anxiety scores for both unilateral and bilateral mastectomy groups improved to normal range over time while scores for women having breast-conserving therapy remained mild. Conclusions: Surgical procedure influences chest physical well-being, distress and anxiety scores in women with DCIS. Our data may help inform surgical decision-making for women with DCIS, and highlight a need for identifying women with high distress at diagnosis who may benefit from targeted psychosocial support. Citation Format: David W. Lim, Helene Retrouvey, Isabel Kerrebijn, Benita Hosseini, Anne C. O'Neill, Tulin D. Cil, Toni Zhong, Stefan O.P. Hofer, David R. McCready, Kelly A. Metcalfe. Does surgical procedure influence psychosocial outcomes after treatment in women with ductal carcinoma in situ? [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr B020.

Area Deprivation Index Is Associated with Quality of Life and Psychosocial Well-being after Breast Cancer Surgery

INTRODUCTION: Neighborhood-level factors have been shown to influence operative outcomes. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and postmastectomy outcomes. METHODS: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 and June 2019. Patient-specific demographics, clinical history, and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into 3 groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). RESULTS: A total of 564 consecutive patients were identified; mostly White (75%) with a mean age of 60.2 ± 12.4 years, mean BMI of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95% CI 43.8–46.0] vs 44.9 [95% CI 43.7–46.1] vs 46.3 [95% CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI 59.32–67.8] vs 69.3 [95% CI 65.1–73.6] vs 69.7 [95% CI 66.4–73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. CONCLUSION: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.

The Role of Cryoablation in Breast Cancer Beyond the Oncologic Control: COST and Breast-Q Patient-Reported Outcomes.

Cryoablation has been established as a minimally invasive alternative to resection of early-stage breast cancer; however, there are no data on the cost and impact on patients' financial, psychosocial, sexual, physical, and cosmetic outcomes utilizing this approach. This study compares cost-effectiveness and patient-reported quality-of-life factors in cryoablation versus resection. Women with early-stage, low-risk infiltrating ductal carcinomas ≤ 1.5 cm underwent cryoablation or resection. Adjuvant therapy was provided according to tumor board recommendations. Direct and indirect costs were tracked for both groups. Financial toxicity and well-being outcome were measured by administering the Comprehensive Score of Financial Toxicity (COST) and BREAST-Q surveys, respectively, at 6-month follow-up. Of the 34 eligible patients, 14 (41.1%) consented for cryoablation and 20 (58.8%) underwent resection. The median (centile) (range) follow-up was 35.0 (21.3) (15-50) months for cryoablation vs. 25 (20.8) (17-50) months for resection [p = 0.6479]. Mean (standard deviation) cost of care for cryoablation versus resection was $2221.70 (615.70) versus $16,896.50 (1332.40) [p < 0.0001], and median financial well-being scores for the cryoablation versus resection groups were 38.0 (34.5, 40.0) versus 10 (5.3, 14.0) [p < 0.0001]. Poor financial well-being was directly correlated with the cost of care [p < 0.0001]. Median psychosocial well-being scores were similar across both groups, however the cryoablation group had higher scores for physical [100 (100, 100) vs. 89 (79, 100); p = 0.0141], sexual [100 (91, 100) vs. 91 (87.5, 91); p = 0.0079], and cosmetic [100 (100, 100) vs. 88 (88, 100); p = 0.0171] outcomes. Cryoablation offers a cost-effective and quality-of-life advantage compared with resection for early-stage, low-risk breast cancer.

Area Deprivation Index is Associated with Variation in Quality of Life and Psychosocial Well-being Following Breast Cancer Surgery.

Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has examined the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. A cross-sectional survey of adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019 was carried out. Patient-specific characteristics and ADI information were abstracted and correlated with postoperative global- (SF-12) and condition-specific (BREAST-Q) quality-of-life performance via multivariable regression. Patients were classified into three ADI terciles: 0-39 (low deprivation), 40-59 (moderate deprivation), and 60-100 (high deprivation). A total of 564 consecutive patients were identified, being mostly white (75%) with mean age of 60.2 ± 12.4 years, median body mass index of 27.8 [interquartile range (IQR) 24.3-32.2) kg/m2, median Charlson Comorbidity Index of 3 (IQR 2-5), and mean ADI of 42.3 ± 25.7. African American and Hispanic patients and those with high BMI were more likely to reside in highly deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, patients in highly deprived neighborhoods had significantly lower mean SF-12 physical (44.9 [95% CI, 43.8-46.0] versus 44.9 [95% CI, 43.7-46.1] versus 46.3 [95% CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95% CI, 59.32-67.8] versus 69.3 [95% CI, 65.1-73.6] versus 69.7 [95% CI, 66.4-73.1], p = 0.01) relative to moderate- and low-deprivation groups. Patients residing in the most deprived neighborhoods were identified to have worse psychological well-being and quality-of-life. The ADI should be incorporated into the shared decision-making process and perioperative counseling to engender value-based and personalized care, especially for vulnerable populations.

Association between area deprivation index and quality of life and psychosocial well-being following breast cancer surgery.

e18612 Background: Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. Methods: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019. Patient-specific demographics, clinical history and ADI information were abstracted and correlated with post-operative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into three groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). Results: A total of 564 consecutive patients were identified; mostly white (75%) with a mean age of 60.2±12.4, mean body mass index (BMI) of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly-deprived neighborhoods (p = 0.003 and p &lt; 0.001). In adjusted models, Patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95%CI, 43.8-46.0] vs. 44.9 [95%CI, 43.7-46.1] vs. 46.3 [95%CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95%CI, 59.32-67.8] vs. 69.3 [95%CI, 65.1-73.6] vs. 69.7 [95%CI, 66.4-73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. Conclusions: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counselling to engender value-based and personalized care, especially for vulnerable populations.

Study of the impact of the ARCH model of parenting on the psychosocial well-being of children and their parents during the COVID-19 pandemic

Introduction: The COVID-19 pandemic and its associated lockdowns have affected the development of children negatively. The ARCH model is a parent-administered, home-based, psychological intervention model to improve the psychosocial well-being of children and their families. The model acts as a set of guidelines and a list of activity modules for parent-child interactions that will promote and enhance the child’s social skills and psychological health. Objective: The objective of the study was to study the effectiveness of a novel innovative psychological model and parenting strategy for promoting the psychosocial well-being of children. Materials and Methods: This is an open prospective single-arm study in a tertiary care hospital with pre-and post-intervention design. Patients aged 3–18 years visiting the outpatient department, admitted to the pediatric ward as well as their parents, and siblings, were enrolled in the study. Data were collected by self-reported questionnaires. The intervention was administered and 1–2 months later we checked for any changes in the psychosocial well-being scores. Results: Fifty participants were enrolled and eight were lost to follow-up. Statistical analysis showed an insignificant difference in the Ryff psychosocial well-being pre-intervention score (208.5±15.1) and post-intervention scores (208.4±14.8) (p=0.847) for parents. KIDSCREEN questionnaire score showed a significant improvement in “social service and peers” subcategory, between pre-intervention score (128.83±17.18) and post-intervention score (131.29±16.60) with a Z score=2.09 (p&lt;0.05). KIDSCREEN questionnaire score also showed improvement in overall score in pre-intervention score (578.64±440.39) and post-intervention score (584.40±444.19) with a Z score=1.66 (p&lt;0.05). Conclusion: Our study found that while the intervention did not have a major impact on the psychosocial well-being of the parents, there was a significant difference effected on the psychosocial well-being of the children.

Abstract P4-09-02: The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q

Abstract Introduction: Although SSO/ASTRO consensus margin guidelines have led to decrease rate of re-excision, some women require additional surgery. Re-excision surgery may cause psychosocial stress and impact cosmetic outcomes and breast satisfaction. The purpose of this study was to assess patient-reported outcomes using the BREAST-Q breast satisfaction, psychosocial wellbeing, and sexual wellbeing subscales for women with breast cancer following index breast-conserving surgery (BCS). Methods: Women with stage 0 to 3 breast cancer undergoing BCS who completed a BREAST-Q from 2010 to 2016 were identified by retrospective review of a prospective database. The BREAST-Q breast conserving therapy module was used to assess outcomes between women with 1 BCS and those with ≥1 re-excision surgery (R-BCS). Baseline characteristics were compared, and linear mixed models were used to analyze associations with BREAST-Q scores over time. Results: Our study group was initially composed of 2570 women that was narrowed to 2549 women after excluding 21 who ultimately underwent mastectomy; 1982 (78%) had 1 BCS and 567 (22%) had ≥1 R-BCS. The median age of the cohort was 57 years (range 26-97). Women with 1 BCS were more likely to be older (p&amp;lt;0.001), have a higher BMI (p=0.01), present with invasive carcinoma (p=0.03), have unifocal disease (p&amp;lt;0.001), undergo surgery post-release of SSO Invasive Guidelines (p&amp;lt;0.001), receive endocrine therapy (p=0.006), and less likely to receive radiation therapy (p=0.02) compared to those with ≥1 R-BCS. At 2-years post-operative, women with ≥1 R-BCS compared to 1 BCS were noted to have lower average breast satisfaction and sexual well-being scores (76.0 vs. 71.8 [p=0.03] and 70.2 vs. 64.0 [p=0.01], respectively). No difference in psychosocial well-being scores existed for up to 5 years of post-operative follow-up. Multivariable linear regression confirmed that undergoing ≥1. R-BCS is a risk factor for decreased breast satisfaction and sexual well-being at 2 years postoperative. On multivariable analysis, re-excision was found to be associated with lower breast satisfaction and sexual well-being scores. (p=0.01 and p=0.02, respectively), while it was not associated with a change in psychosocial wellbeing score (p=0.07). Factors such as Race, BMI, and marital status were not associated with any difference across all subscales (all p&amp;gt;0.1). Chemotherapy and radiotherapy were associated with lower scores across all subscales (Table). Younger age was associated with lower psychosocial and sexual well-being scores (both p&amp;lt;0.001), and endocrine therapy was associated with a lower sexual well-being score (p=0.01). Conclusions: Psychosocial well-being in women with 1 BCS for breast cancer were largely comparable over time to those who underwent ≥1 R-BCS. At 2 years post-operative, women with 1-BCS had lower breast satisfaction and sexual well-being, but this difference did not remain at later time periods. These findings may help in counseling women who are concerned of satisfaction and quality of life outcomes with BCS if breast re-excision was necessary. Multivariable analysis of BREAST-Q Subscale scoresEstimateStandard Errorp valueBreast SatisfactionAge at surgery-0.0690.0480.147BMI-0.1380.0810.088Chemotherapy-2.5421.0260.015Adjuvant radiation-3.4371.5830.031Hormonal therapy-0.6511.1700.119≥1 R-BCS vs. 1 BCS-2.5420.8840.008Psychosocial well-beingAge at surgery0.1980.043&amp;lt;0.001BMI-0.079-0.0790.287 Chemotherapy-3.2090.9330.001Adjuvant radiation-4.5091.4600.004Hormonal therapy0.2081.0740.528≥1 R-BCS vs. 1 BCS-1.4450.7930.059Sexual well-beingAge at surgery0.2700.072&amp;lt;0.001BMI-0.1140.1180.337Chemotherapy-4.7131.428&amp;lt;0.001Adjuvant radiation-7.6292.493&amp;lt;0.001Hormonal therapy-1.1801.7080.008≥1 R-BCS vs. 1 BCS-2.9661.2190.015 Citation Format: Regina Matar, Meghan Flanagan, Sarah Fuzesi, Kathyrn Haglich, Shen Yin, Varadan Sevilimedu, Jonas Nelson, Mary L. Gemignani. The impact of breast conserving surgery re-excision on patient-reported outcomes using the BREAST-Q [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-02.

Do You Really Want to Be Forever Young? Emotional Health and Psychosocial Well-being by Relative Birth Quarter in Canadian Adolescents

PurposeThose born earlier within cohorts of similarly aged children tend to outperform peers in athletic and academic pursuits. Subsequent evidence suggests relatively younger children may also experience worse emotional and psychosocial health; however, evidence from middle adolescents is limited. This study assessed whether depression, anxiety, and psychosocial well-being differed by the relative birth quarter (RBQ) within a cohort of grades 9–12 in secondary schools across Canada. MethodsData from the 2018–19 student self-report surveys of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behavior study were analyzed. Students having made normative progress were categorized into RBQs by the provincial enrollment cutoff date (n = 49,921). Hierarchical modeling approaches assessed whether self-reported depression, anxiety, psychosocial well-being, and positive controls differed by RBQ after controlling for covariates. ResultsDespite relative age effects for positive control outcomes, no significant difference was detected for anxiety and depression scores or likelihood of meeting thresholds for having clinically relevant symptoms. However, a significant difference emerged between RBQs for psychosocial well-being scores; post hoc tests found that psychosocial well-being scores were lower in the fourth RBQ than those in all prior quarters. DiscussionResults agree with limited findings that relative age differences in emotional health are not significant in older cohorts. Nonetheless, relatively older individuals reported very small (d = .04–.05) advantages in psychosocial well-being than their youngest peers, which aligns with previous data. Longitudinal approaches to assess relative age effects on mental health during and throughout the transition into middle adolescence are warranted.

Longitudinal Study of Psychosocial Outcomes Following Surgery in Women with Unilateral Nonhereditary Breast Cancer.

Rates of bilateral mastectomy are rising in women with unilateral, nonhereditary breast cancer. We aim to characterize how psychosocial outcomes evolve after breast cancer surgery. We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network in Toronto, Canada between 2014 and 2017. Women completed validated psychosocial questionnaires (BREAST-Q, Impact of Event Scale, Hospital Anxiety & Depression Scale) preoperatively, and at 6 and 12 months following surgery. Change in psychosocial scores was assessed between surgical groups using linear mixed models, controlling for age, stage, and adjuvant treatments. P < .05 were significant. A total of 475 women underwent unilateral lumpectomy (42.5%), unilateral mastectomy (38.3%), and bilateral mastectomy (19.2%). There was a significant interaction (P < .0001) between procedure and time for breast satisfaction, psychosocial and physical well-being. Women having unilateral lumpectomy had higher breast satisfaction and psychosocial well-being scores at 6 and 12 months after surgery compared with either unilateral or bilateral mastectomy, with no difference between the latter two groups. Physical well-being declined in all groups over time; scores were not better in women having bilateral mastectomy. While sexual well-being scores remained stable in the unilateral lumpectomy group, scores declined similarly in both unilateral and bilateral mastectomy groups over time. Cancer-related distress, anxiety, and depression scores declined significantly after surgery, regardless of surgical procedure (P < .001). Psychosocial outcomes are not improved with contralateral prophylactic mastectomy in women with unilateral breast cancer. Our data may inform women considering contralateral prophylactic mastectomy.

Mental Health Associations with Academic Performance and Education Behaviors in Canadian Secondary School Students

Course grades, as an indicator of academic performance, are a primary academic concern at the secondary school level and have been associated with various aspects of mental health status. The purpose of this study is to simultaneously assess whether symptoms of mental illness (depression and anxiety) and mental well-being (psychosocial well-being) are associated with self-reported grades (in their primary language [English or French] and math courses) and education behaviors (school days missed due to health, truancy, and frequency of incomplete homework) in a sample of secondary school students across Canada ( n = 57,394). Multivariate imputation by chained equations and multilevel proportional odds logistic regressions were used to assess associations between mental health scores, academic performance and education behaviors. Lower depression and higher psychosocial well-being scores were associated with better grade levels in both math and language courses, as well as better education behaviors. In turn, better education behaviors were associated with higher course grades. Depression scores and psychosocial well-being scores remained associated with higher grades after controlling for education behaviors, however the magnitude of association was diminished. Results indicate that the effects of mental health factors were partially attenuated by education behaviors, suggesting while reduced class attendance and poor homework adherence were associated with both academic outcomes and mental health, they do not account entirely for the association between lower grades and worse mental health.

The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery

PurposeSome studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups.MethodsPatients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011–3/2019, were identified from a prospectively maintained database. QoL was prospectively evaluated using the Breast-Q questionnaire. Comparisons were made between women < 60 and ≥ 60 years.ResultsOne hundred thirty-three patients were included. Seventy-three of them were ≥ 60 years old. 15 (20.5%) of them received a round-block technique (RB) / oncoplastic breast-conserving surgeries (OBCS), 10 (13.7%) underwent nipple-sparing mastectomies (NSM) with deep inferior epigastric perforator flap (DIEP) reconstruction, 23 (31.5%) underwent conventional breast-conserving surgeries (CBCS), and 25 (34.2%) received total mastectomy (TM). Sixty patients were younger than 60 years, 15 (25%) thereof received RB/OBCS, 22 (36.7%) NSM/DIEP, 17 (28.3%) CBCS, and 6 (10%) TM. Physical well-being chest and psychosocial well-being scores were significantly higher in older women compared to younger patients (88.05 vs 75.10; p < 0.001 and 90.46 vs 80.71; p = 0.002, respectively). In multivariate linear regression, longer time intervals had a significantly positive effect on the scales Physical Well-being Chest (p = 0.014) and Satisfaction with Breasts (p = 0.004). No significant results were found concerning different types of surgery.ConclusionOur findings indicate that age does have a relevant impact on postoperative QoL. Patient counseling should include age-related considerations, however, age itself cannot be regarded as a contraindication for oncoplastic surgery.

Perceived Parenting Styles and Psycho-social Wellbeing of Nigerian Adolescents

The influence of parenting styles on the psychosocial wellbeing of Nigerian adolescents is yet of be given adequate research attention. This study bridges the gap in knowledge. Findings may be useful in planning appropriate interventions program necessary to improve the psychosocial wellbeing of adolescents in Osun state, southwestern Nigeria and relation with similar social-cultural backgrounds. Purposive sampling technique was used to select 332 (mean age = 14) in-school adolescents who responded to Mental Health Continuum – Short Form (MHS-SF) and Parenting Style Instrument (PSI). Descriptive and inferential statistics (Regression, Independent sample t-test and One Way ANOVA) were used for data analysis. A low level of psychosocial wellbeing was observed among the adolescents. Prevalence of very low levels of emotional wellbeing (16.9%), social wellbeing (22%), and psychological wellbeing (19.3%) were reported. Patterns of observed parenting styles are authoritative parenting style (45.5%, 41.6%, and 12.9%), authoritarian parenting style (53%, 30.7% and 16.3%); permissive parenting style (64.2%, 20.7% and 15.1%) for low, high and very high levels respectively. No significant gender difference was observed in the psychosocial wellbeing scores of the adolescents; a significant religious affiliation difference was found in the social wellbeing of the participants. Adolescents from public schools manifested higher levels of social wellbeing than their counterparts from private schools. Parenting styles significantly predict level of psychosocial wellbeing of the adolescents. Neither family type nor family size had significant influence on the level of psycho-social wellbeing of the adolescents.

Abstract PD6-1: BREAST-Q satisfaction and quality of life outcomes in young women undergoing mastectomy and reconstruction for breast cancer

Abstract Background: Young women with breast cancer (BC) often receive aggressive local therapy and are more likely to undergo (bilateral) mastectomy and receive postmastectomy radiation (RT) than older women. Our previous work suggested better quality of life (QOL) outcomes among women undergoing breast conserving therapy (BCT) vs. mastectomy, even with reconstruction (recon), although limited data was available regarding recon. In the current analysis, we sought to understand the impact of recon, accounting for RT, on long-term satisfaction and QOL. Methods: Between 10/2016-11/2017, we administered the BREAST-Q, a validated patient-reported outcomes measure designed to evaluate satisfaction and QOL after breast cancer surgery and recon, to 743 women in the Young Women’s Breast Cancer Study, a multi-site prospective cohort that enrolled women diagnosed (dx’d) at age &amp;lt; 40 from 2006-2016. Demographic and treatment information was obtained by surveys and chart review. Recon was defined as autologous, implant or complex (combination of autologous and implant). Mean BREAST-Q scores for each domain (breast satisfaction, physical, psychosocial, and sexual) were compared by recon types and stratified by receipt of RT; higher BREAST-Q scores (range: 0-100) indicate better QOL. Linear regression was used to identify predictors of BREAST-Q scores. Results: 584 women with Stage 0-3 BC completed the Breast-Q at a median of 5.7 [range 2-10] years from dx), 357 (61%) had mastectomy and recon and were included in the analytic sample. Median age at dx was 36 years; 85% had stage 0, 1 or 2 disease; 41% received RT and 76% underwent bilateral mastectomy. 90.5% underwent immediate recon; of which 65.5% were tissue expander placement. Definitive recon included autologous tissue in 16%; implants in 81% and complex recon in 3%. Mean BREAST-Q breast satisfaction, psychosocial, and physical well-being scores differed based on recon type accounting for RT (Table 1). Significantly lower scores for breast satisfaction were seen in women having implant +RT. Scores were not impacted by bilateral procedure, timing of recon, use of tissue expander, extent of axillary surgery, cancer stage or other treatment factors. In multivariate analyses, receipt of RT, lymphedema and implant-based recon were associated with lower breast satisfaction scores. Physical well-being scores were lower for those with complex recon, for non-White women, for women who reported being financially uncomfortable, for those with lymphedema, and for those &amp;lt;5 years from surgery. Psychosocial well-being scores were lower for women who received RT, had BMI &amp;gt;25, and for those who reported being financially uncomfortable. Sexual well-being scores were lower for women with a BMI &amp;gt;25 and for those who reported being financially uncomfortable. Conclusion Type of recon and receipt of radiation among young survivors who undergo mastectomy and recon for early breast cancer appears to have a differential impact on satisfaction and QOL. Our finding of lower breast satisfaction among young women who received RT, particularly after implant recon, underscores the importance of counseling regarding surgical options, especially for women who may receive RT after mastectomy and who are candidates for BCT. Table 1. Unadjusted BREAST-Q scores stratified by RTBREAST-Q DomainAutologous -RT N=29Autologous +RT N=27Implant -RT N=174Implant +RT N=113Complex N=13Global p-valueSatisfaction with Breasts, mean (sd)67 (19)63 (18)64 (18)53 (18)58 (22)&amp;lt;0.01Physical well-being, mean (sd)81 (13)80 (14)80 (15)77 (14)67 (18)0.01Psychosocial well-being, mean (sd)71 (18)64 (18)72 (20)66 (23)62 (20)0.03Sexual well-being, mean (sd)54 (21)50 (24)52 (20)47 (22)48 (27)0.26RT= radiation Citation Format: Laura Dominici, Jiani Hu, Hee Jeong Kim, Tari King, Kathryn Ruddy, Rulla Tamimi, Jeffrey Peppercorn, Lidia Schapira, Virginia Borges, Stephen Come, Ellen Warner, Julia Wong, Ann Partridge, Shoshana Rosenberg. BREAST-Q satisfaction and quality of life outcomes in young women undergoing mastectomy and reconstruction for breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD6-1.

Establishing Institution-Specific Normative Data for the BREAST-Q Reconstruction Module: A Prospective Study.

Breast satisfaction in general female populations is relatively unknown and prior research populations do not reflect our community. We sought to assess breast satisfaction in a cohort of female participants utilizing the BREAST-Q and determine the impact of participant-related factors. Females with no history of breast cancer or breast surgery attending gynecology appointments completed preoperative BREAST-Q reconstruction modules and demographic forms in this prospective, single-center, patient-reported outcomes study. We also assessed participant-related factors capable of influencing BREAST-Q scores. Three hundred females were included. Increasing body mass index had significant associations with lower Satisfaction with Breasts and Psychosocial Well-being scores. Increasing age was associated with significantly lower Sexual Well-being scores. African Americans had significantly higher scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being compared with Caucasians. Bra cup sizes A and C were associated with significantly higher Psychosocial Well-being scores than other sizes. Bra cup sizes A, B, and C were associated with significantly higher Sexual Well-being and Physical Well-being: Chest scores than larger sizes. Bra cup sizes B and C were associated with significantly higher Physical Well-being: Abdomen scores than size DD. Bra cup size A was associated with significantly higher Satisfaction with Breasts scores than sizes DD and >DD. Bra cup size C was associated with significantly higher Satisfaction with Breasts scores than larger sizes. Body mass index, age, race, and bra cup sizes significantly impact BREAST-Q scores in our population. Determining normative BREAST-Q scores in female populations could represent important baselines for breast outcomes research.

Establishing Institution-specific Normative Data for the BREAST-Q Reconstruction Module: A Prospective Study

Background Breast satisfaction in general female populations is relatively unknown and prior research populations do not reflect our community. Objectives We sought to assess breast satisfaction in a cohort of female participants utilizing the BREAST-Q and determine the impact of participant-related factors. Methods Females with no history of breast cancer or breast surgery attending gynecology appointments completed preoperative BREAST-Q reconstruction modules and demographic forms in this prospective, single-center, patient-reported outcomes study. We also assessed participant-related factors capable of influencing BREAST-Q scores. Results Three hundred females were included. Increasing body mass index had significant associations with lower Satisfaction with Breasts and Psychosocial Well-being scores. Increasing age was associated with significantly lower Sexual Well-being scores. African Americans had significantly higher scores for Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being compared with Caucasians. Bra cup sizes A and C were associated with significantly higher Psychosocial Well-being scores than other sizes. Bra cup sizes A, B, and C were associated with significantly higher Sexual Well-being and Physical Well-being: Chest scores than larger sizes. Bra cup sizes B and C were associated with significantly higher Physical Well-being: Abdomen scores than size DD. Bra cup size A was associated with significantly higher Satisfaction with Breasts scores than sizes DD and >DD. Bra cup size C was associated with significantly higher Satisfaction with Breasts scores than larger sizes. Conclusions Body mass index, age, race, and bra cup sizes significantly impact BREAST-Q scores in our population. Determining normative BREAST-Q scores in female populations could represent important baselines for breast outcomes research. Level of Evidence: 2.

Asylum seekers’ mental health and treatment utilization in a three months follow-up study after transfer from a state registration-and reception-center in Germany

Even though asylum seekers show a high prevalence of trauma-related disorders and comorbid psychological stress symptoms, little is known about how their mental health develops during the asylum process and what options of care are provided. We aimed to investigate the mental health and treatment utilization of asylum seekers after they were transferred from a state registration- and reception-center to municipal shelters in Germany. N = 228 asylum seekers with on-going asylum procedure were recruited in the psychosocial walk-in clinic located in a state registration- and reception-center. We firstly captured symptoms of posttraumatic stress, depression, anxiety disorders, quality of life, as well as alcohol or drug abuse. Subsequently we performed a follow-up after three months to evaluate a potential shift in symptoms and determining rates of access to treatment. In the pre-post psychometric assessment, there were statistically significant changes in depression (PHQ-2), panic (PHQ-PD) and psychosocial well-being scores (WHO-5). However, all these scores still remained within a clinical relevant range, respectively. Traumatic stress (PC-PTSD-5) and general anxiety scores (GAD-2) did not change significantly. Although N = 44 (66%) of the interviewed patients had been referred to psychotherapy initially, none (0%) of them had received outpatient psychotherapeutic treatment after three months. Our results emphasize a strong need for low-threshold, cultural adapted psychotherapeutic treatment for asylum seekers.