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The Effect of Breast Cancer Stage on Patient Satisfaction and Hr-QoL in Patients Undergoing Mastectomy and Breast Reconstruction
Pathik Aravind, MBBS1, Nathan Louie, MHS1, Viraj Ambalam, MBBS, MPH1, Pooja S. Yesantharao, MS1, Leen El Eter1, Mehran Habibi, MD2, Kristen P. Broderick, MD1, Carisa M. Cooney, MPH1, Gedge D. Rosson, MD1, Michele A. Manahan, MD, MBA1.
1Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND: Patient reported outcomes like the BREAST-Q provides quantitative data to health care providers that enables informed patient-centric care. However, these outcomes maybe influenced by patient-, disease- or treatment-related factors. In this study, we assessed the impact of the breast cancer severity on patient satisfaction assessed by the BREAST-Q reconstruction module. METHODS: We conducted a retrospective review of a prospectively collected database (2010-2015) of breast reconstruction patients. We reviewed data regarding patient demographics, cancer diagnosis and treatment. Patients were divided into 2 groups - Group 1: DCIS and Stage I invasive breast cancer, and Group 2: Stage II, III and IV invasive breast cancer. Patient satisfaction scores at baseline, 12-months post-reconstruction and change of score from baseline to 12-months post-reconstruction was used to assess patient satisfaction. BREAST-Q scores were compared using the independent t-test. Adjusted analysis was also performed using the linear regression model, controlling for differences in patient demographics and possible confounders.
RESULTS: 215 patients were included in our study. Group I had 152 (70.7%) patients and Group 2 had 63 (29.3%) patients. Patient demographics across the 2 groups was comparable, except smoking which was higher in Group 2 (p = 0.03) and type of mastectomy (p < 0.01). Timing and type of reconstruction was well matched between the 2 groups. Univariate analysis (Table 1) showed that baseline Satisfaction with breast scores was significantly higher in Group I (62.5 vs. 52.4; p = 0.01). At 12-months post-reconstruction; scores for Satisfaction with breasts (66.9 vs. 60.6; p = 0.03), Psychosocial well-being (78.6 vs. 69.8, p < 0.01) and Sexual well-being (61.1 vs. 49.8, p < 0.01) were significantly higher in Group 1. For change in score from baseline to 12 months post-reconstruction, Satisfaction with breast scores showed a larger mean change in score for Group 2 favoring post-reconstruction scores, but statistical significance was not observed (4.4 vs. 8.2, p = 0.39). However, change in score for Sexual well-being was significantly different, with Group 1 favoring post-reconstruction scores and Group 2 favoring baseline scores (1.9 vs. -7.3, p = 0.03). These findings were consistent after adjusting for potential confounders in our risk-adjusted analysis.
CONCLUSION: Our analysis showed that severity of breast cancer significantly impacts patient satisfaction and well-being, with more severe disease amounting to lower satisfaction. Thus, severity of breast cancer is an important consideration for patient reported outcomes research to minimize subjective bias and maximize the quality of interpretation of results.

Table 1: Comparing BREAST-Q scores: Group 1 (DCIS/Stage I) vs. Group 2 (Stage II/III/IV)
BREAST-Q Sub-domainsTimepointsGroup 1 (n=152)Group 2(n=63)p-value
Mean (SD)Mean (SD)
Satisfaction with breastBaseline62.5 (1.9)52.4 (3.1)0.01
12-mo post-reconstruction66.9 (1.6)60.6 (2.3)0.03
Delta4.4 (2.3)8.2 (0.4)0.39
Satisfaction with outcomeϕBaselinen/an/an/a
12-mo post-reconstruction77.7 (1.8)71.3 (2.9)0.06
Deltan/an/an/a
Psychosocial well-beingBaseline74.3 (1.6)68.9 (2.3)0.06
12-mo post-reconstruction78.6 (1.7)69.8 (2.6)<0.01
Delta3.9 (1.8)0.9 (2.9)0.36
Sexual well-beingBaseline58.2 (1.7)57.8 (2.9)0.92
12-mo post-reconstruction61.1 (2.1)49.8 (2.9)<0.01
Delta1.9 (2.2)-7.3 (4.0) *0.03
Physical well-being: ChestBaseline80.4 (1.2)79.5 (2.2)0.71
12-mo post-reconstruction78.8 (1.3)75.7 (2.3)0.22
Delta-1.5 (1.3) *-3.8 (2.2) *0.34
Physical well-being: AbdomenBaseline90.2 (1.0)87.7 (1.9)0.20
12-mo post-reconstruction79.7 (2.3)78.8 (3.0)0.82
Delta-11.3 (2.6) *-7.0(4.2) *0.29
*Delta scores were obtained by subtracting baseline scores from 12-month post-operative scores. Thus, a negative value favors baseline score over post-operative score.ϕThere is no baseline score for “Satisfaction with outcome” and therefore no “Delta”.


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