Monitoring Patient-Centered Outcomes Through The Progression Of Breast Reconstruction: A Multi-Centered Prospective Longitudinal Evaluation

Objective:

Comprehensive treatment of breast cancer can be a psychologically stressful experience for patients.  Overall, most studies have shown that having breast reconstruction has a positive influence on patient satisfaction and health-related quality of life (HRQoL) at the conclusion of treatment.  However, no study has critically evaluated the changes to these patient-centered outcomes (PROs) during the process of undergoing breast reconstruction.  The purpose of this study was to prospectively evaluate the temporal changes to patient-centered metrics through the progression of breast reconstruction.

Methods:

An IRB-approved prospective, multi-institutional study was performed for all patients undergoing breast reconstruction between 2009-2011.  The Breast-Q reconstruction questionnaire was used for evaluation of HRQoL.  The questionnaire was administered at five intervals in the perioperative period (prior to surgery, 1, 3, 6, and 9 months following surgery).  Longitudinal evaluation was performed to assess changes to HRQoL metrics during this perioperative interval. An a priori value of 0.05 was used for statistical significance.

Results:

110 patients were enrolled in the study with 100 patients (91.9%) completing appropriate follow-up.  Pre-operative HRQoL scores were higher in patients electing to forgo reconstruction (p<0.004), while post-operative HRQoL scores consistently deteriorated within this cohort at multiple time points following mastectomy as compared to patients who underwent reconstruction.  When subgroups of patients undergoing various types of reconstruction were isolated, results indicated lower initial HRQoL scores in delayed reconstruction (p<0.05) as compared to immediate reconstruction.  These scores did, however, merge at approximately 9 months post-operatively.  On further analysis, implant-based reconstruction resulted in higher HRQoL scores in most domains at the 6 and 9 month evaluations.

Conclusions:

Temporal changes to HRQoL outcomes occur through the progression of breast reconstruction.  Within the first year of surgery, early decreases are mirrored by significant increases at later time points above baseline levels when evaluating most forms of breast reconstruction.  Choosing against reconstruction will likely result in continued deterioration of HRQoL for patients undergoing breast cancer surgery, but steady improvements can be expected if delayed reconstruction is chosen.