A Gandhi1, P Duxbury2, J Murphy2, P Foden3, F Lalloo4, T Clancy4, J Wisely5, C C Kirwan6, A Howell6, D G Evans7. 1. Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: ashu.gandhi@mft.nhs.uk. 2. Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK. 3. Department of Medical Statistics, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK. 4. Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 5. Department of Clinical Psychology, Laureate House, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. 6. Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. 7. Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Abstract
BACKGROUND: Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS: We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS: Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION: We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
BACKGROUND: Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS: We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS: Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION: We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
Authors: Anthony Howell; Ashu Gandhi; Sacha Howell; Mary Wilson; Anthony Maxwell; Susan Astley; Michelle Harvie; Mary Pegington; Lester Barr; Andrew Baildam; Elaine Harkness; Penelope Hopwood; Julie Wisely; Andrea Wilding; Rosemary Greenhalgh; Jenny Affen; Andrew Maurice; Sally Cole; Julia Wiseman; Fiona Lalloo; David P French; D Gareth Evans Journal: Cancers (Basel) Date: 2020-12-09 Impact factor: 6.639