Highlights
- •Patient reported outcomes (PRO) allow patients' perception of health care to be evaluated.
- •Understanding factors impacting PRO's that are within the control of the surgeons are essential to improve outcomes.
- •The volume of tissue removed during breast conservation surgery, as well as the need for re-excision impact PRO's.
- •The negative impact of re-excisions of PRO's supports their consideration as a quality measure in the performance of breast conservation surgery.
- •Satisfaction with breast, and psychological and physical well-being of the chest are negatively affected by the volume of breast tissue removed.
Abstract
Background
Patient reported outcomes (PRO's) are a valuable tool in obtaining the patients' perspective
on the effectiveness of breast conservation surgery. Investigation has primarily been
focused on patient and disease related factors impacting PRO's, with a limited focus
on surgically modifiable factors. We investigate the impact that the volume of breast
tissue removed, and performance of re-excisions have on PRO's.
Methods
Retrospective evaluation of the BREAST-Q (breast conservation module) in patients
undergoing breast conserving surgery over a 3 year period. Multivariate analysis of
patient, disease, and treatment related factors impacting PRO's.
Results
163 patients completed the BREAST-Q. The median satisfaction with breast score was
67 (IQR, 48–88). Increasing volume of resected breast tissue was negatively associated
with appearance of the breast (−0.05/cm3 (CI; −0.08 to −0.01)), as was the performance of re-excisions (−6.59 (CI; −14.73
– 0)). Physical well-being of chest was negatively associated with the volume of breast
tissue removed (−0.05/cm3 (CI; −0.08 – 0)), but not re-excisions. Psychosocial well-being
was negatively affected by the volume of tissue removed ((-0.04/cm3(CI; −0.07 – 0)), and re-excisions (−2.88 (CI; −10.96 – 0)). Patient body mass index,
disease stage, receipt of Tamoxifen, as well as axillary lymph node dissection also
impacted BREAST-Q domain scores.
Conclusion
The removal of larger volumes of breast tissue and performance of re-excisions negatively
impact patient quality of life and breast satisfaction following breast conserving
surgery. Optimal patient reported outcomes are associated with accurate tumour removal,
which minimizes re-excisions and the removal of normal breast tissue.
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Article info
Publication history
Published online: March 06, 2022
Accepted:
March 1,
2022
Received in revised form:
January 31,
2022
Received:
November 19,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
