SAN DIEGO – Slightly more than half of women who underwent breast-conserving surgery rated their cosmetic outcome as "good" and 30% rated it as "fair," results from a large online survey showed.
These percentages are lower than would be predicted, based on currently published studies, Dr. Christine E. Hill-Kayser said at the annual meeting of the American Society for Radiation Oncology.
Dr. Christine Hill-Kayser
"In the modern era, more than 50% of breast cancer patients undergo breast-conserving treatment," said Dr. Hill-Kayser of the department of radiation oncology at the University of Pennsylvania, Philadelphia. "Based on available medical literature, more than 90% achieve good or excellent cosmesis based on physician assessment. The rationale for our study was to assess breast cancer survivors’ views on cosmetic outcomes after breast-conserving treatment, and to assess long-term and late effects described by breast cancer survivors after completion of breast-conserving treatment."
She and her associates gathered data from 1,046 breast cancer survivors who voluntarily used an Internet-based tool for creation of survivorship care plans between October 2009 and April 2010. Also available through the OncoLink Web site run by the University of Pennsylvania, the tool allows survivors to enter data anonymously regarding diagnosis, demographics, treatments received, and side effects/late effects experienced, and provides them with customized guidelines for future care.
One component of the tool is a modified version of the Harvard Breast Cosmesis Scale, which poses the following question: How would you rate the cosmetic appearance of the affected breast compared to your other breast? Answer options include "excellent" (almost identical to untreated breast), "good" (minimal difference between breasts), "fair" (obvious difference between breasts but without major distortion), and "poor" (major functional and aesthetic sequelae).
The median age of the 1,046 respondents was 52 years, and 77% identified themselves as residents of the United States. Dr. Hill-Kayser reported that 503 (48%) had undergone lumpectomy followed by radiation therapy (classified as breast-conserving treatment) and 522 (49%) had undergone mastectomy. The remaining 3% did not undergo primary breast surgery.
Of the patients who underwent breast-conserving treatment, 16% rated their cosmetic outcome as excellent, 52% as good, 30% as fair, and 2% as poor. Of the patients who underwent mastectomy with reconstruction, 13% rated their cosmetic outcome as excellent, 48% as good, 30% as fair, and 9% as poor. The responses were statistically similar between both groups (P = .54).
Dr. Hill-Kayser also presented results from a subset of 208 respondents in the breast-conserving testament group who were queried about the incidence of late and/or long-term effects from their treatment. Reported effects included chronic skin and soft-tissue changes (43%), chronic breast or arm pain (21%), loss of shoulder flexibility (21%), and chronic arm swelling (8%).
"Cosmetic outcome is less likely to be classified as excellent or good by survivors after breast-conserving treatment than would be predicted by their health care providers," Dr. Hill-Kayser concluded. "Based on this convenience sample frame, survivor views on cosmesis may be similar after breast-conserving treatment vs. mastectomy and reconstruction. Survivor-reported chronic pain and musculoskeletal concerns are also higher than expected after breast-conserving treatment. Patient-reported outcomes should be considered in decisions regarding treatment paradigms."
She also noted that the limitations of using a convenience sample frame are "somewhat offset by the benefit of anonymity."
Dr. Hill-Kayser said that she had no relevant financial conflicts to disclose.