TY - JOUR
T1 - Association of Local Therapy with Quality-of-Life Outcomes in Young Women with Breast Cancer
AU - Dominici, Laura
AU - Hu, Jiani
AU - Zheng, Yue
AU - Kim, Hee Jeong
AU - King, Tari A.
AU - Ruddy, Kathryn J.
AU - Tamimi, Rulla M.
AU - Peppercorn, Jeffrey
AU - Schapira, Lidia
AU - Borges, Virginia F.
AU - Come, Steven E.
AU - Warner, Ellen
AU - Wong, Julia S.
AU - Partridge, Ann H.
AU - Rosenberg, Shoshana M.
N1 - Funding Information:
Genomic Health) and serving as information service faculty and on the virtual tumor board for Precisca Cancer outside the submitted work. Dr Peppercorn reported having a spouse who is an employee of GlaxoSmithKline outside the submitted work. Dr Rosenberg reported receiving grants from the Agency for Healthcare Research and Quality, Breast Cancer Research Foundation, and Susan G. Komen Foundation during the conduct of the study. No other disclosures were reported.
Funding Information:
part by grant SAC1000008 from the Susan G. Komen Foundation (Dr Partridge), grant BCRF17-121 from the Breast Cancer Research Foundation (Dr Partridge), and grant K01HS023680 from the Agency for Healthcare Research and Quality (Dr Rosenberg).
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Importance: Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown. Objective: To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors. Design, Setting, and Participants: This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study. Exposures: Primary breast surgery, reconstruction, and radiotherapy. Main Outcomes and Measures: Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain. Results: A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P =.007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P <.001). Conclusions and Relevance: These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
AB - Importance: Increasing rates of bilateral mastectomy have been most pronounced in young women with breast cancer, but the association of surgery with long-term quality of life (QOL) remains largely unknown. Objective: To examine the association of surgery with longer-term satisfaction and QOL in young breast cancer survivors. Design, Setting, and Participants: This multicenter cross-sectional study of a prospective cohort was conducted from October 2016 to November 2017, at academic and community hospitals in North America. Women 40 years or younger enrolled in the Young Women's Breast Cancer Study were assessed. Data analysis was performed from during a 1- to 2-year period after conclusion of the study. Exposures: Primary breast surgery, reconstruction, and radiotherapy. Main Outcomes and Measures: Mean BREAST-Q breast satisfaction and physical, psychosocial, and sexual well-being scores were compared by type of surgery; higher BREAST-Q scores (range, 0-100) indicate better QOL. Linear regression was used to identify demographic and clinical factors associated with BREAST-Q scores for each domain. Results: A total of 560 women with stage 0 to III breast cancer (median age at diagnosis, 36 years; range, 17-40 years; 484 [86%] with stage 0-II disease) completed the BREAST-Q a median of 5.8 years (range, 1.9-10.4 years) from diagnosis. A total of 290 patients (52%) of patients underwent bilateral mastectomy, 110 patients (20%) underwent unilateral mastectomy, and 160 patients (28%) received breast-conserving therapy. Among mastectomy patients, 357 (89%) had reconstruction and 181 (45%) received radiotherapy. In multivariate analyses, implant-based reconstruction (vs autologous) was associated with decreased breast satisfaction (β = -7.4; 95% CI, -12.8 to -2.1; P =.007) and complex reconstruction (vs autologous) with worse physical well-being (β = -14.0; 95% CI, -22.2 to -5.7; P <.001). Conclusions and Relevance: These results suggest that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
UR - http://www.scopus.com/inward/record.url?scp=85114479100&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114479100&partnerID=8YFLogxK
U2 - 10.1001/jamasurg.2021.3758
DO - 10.1001/jamasurg.2021.3758
M3 - Article
C2 - 34468718
AN - SCOPUS:85114479100
VL - 156
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 10
M1 - 3758
ER -