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Patient reported outcomes following breast conserving surgery are improved by minimizing re-excisions and excessive breast tissue removal

  • Chris Baliski
    Correspondence
    Corresponding author. BC Cancer – Kelowna, Dept. of Surgical Oncology, 399 Royal Avenue, Kelowna, British Columbia, V1Y 5L3, Canada.
    Affiliations
    BC Cancer – Kelowna, Dept. of Surgical Oncology, University of British Columbia Okanagan, Dept. of Surgery, Kelowna General Hospital, Kelowna, BC, Canada
    Search for articles by this author
  • Brendan Bakos
    Affiliations
    Cancer Surveillance and Outcomes, BC Cancer, Vancouver, BC, Canada
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      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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