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      The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery

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          Abstract

          Purpose

          Some studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups.

          Methods

          Patients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011–3/2019, were identified from a prospectively maintained database. QoL was prospectively evaluated using the Breast-Q questionnaire. Comparisons were made between women < 60 and ≥ 60 years.

          Results

          One hundred thirty-three patients were included. Seventy-three of them were ≥ 60 years old. 15 (20.5%) of them received a round-block technique (RB) / oncoplastic breast-conserving surgeries (OBCS), 10 (13.7%) underwent nipple-sparing mastectomies (NSM) with deep inferior epigastric perforator flap (DIEP) reconstruction, 23 (31.5%) underwent conventional breast-conserving surgeries (CBCS), and 25 (34.2%) received total mastectomy (TM). Sixty patients were younger than 60 years, 15 (25%) thereof received RB/OBCS, 22 (36.7%) NSM/DIEP, 17 (28.3%) CBCS, and 6 (10%) TM. Physical well-being chest and psychosocial well-being scores were significantly higher in older women compared to younger patients (88.05 vs 75.10; p < 0.001 and 90.46 vs 80.71; p = 0.002, respectively). In multivariate linear regression, longer time intervals had a significantly positive effect on the scales Physical Well-being Chest ( p = 0.014) and Satisfaction with Breasts ( p = 0.004). No significant results were found concerning different types of surgery.

          Conclusion

          Our findings indicate that age does have a relevant impact on postoperative QoL. Patient counseling should include age-related considerations, however, age itself cannot be regarded as a contraindication for oncoplastic surgery.

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          Most cited references25

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          Cancer statistics, 2016.

          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the National Cancer Institute (Surveillance, Epidemiology, and End Results [SEER] Program), the Centers for Disease Control and Prevention (National Program of Cancer Registries), and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2016, 1,685,210 new cancer cases and 595,690 cancer deaths are projected to occur in the United States. Overall cancer incidence trends (13 oldest SEER registries) are stable in women, but declining by 3.1% per year in men (from 2009-2012), much of which is because of recent rapid declines in prostate cancer diagnoses. The cancer death rate has dropped by 23% since 1991, translating to more than 1.7 million deaths averted through 2012. Despite this progress, death rates are increasing for cancers of the liver, pancreas, and uterine corpus, and cancer is now the leading cause of death in 21 states, primarily due to exceptionally large reductions in death from heart disease. Among children and adolescents (aged birth-19 years), brain cancer has surpassed leukemia as the leading cause of cancer death because of the dramatic therapeutic advances against leukemia. Accelerating progress against cancer requires both increased national investment in cancer research and the application of existing cancer control knowledge across all segments of the population.
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            Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q.

            Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients. Patient interviews, focus groups, expert panels, and a literature review were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and reconstruction) were developed and cognitive debriefing interviews used to pilot each questionnaire. Revised questionnaires were field tested with 1950 women at five centers in the United States and Canada (response rate, 72 percent); 491 patients also completed a test-retest questionnaire. Rasch measurement methods were used to construct scales, and traditional psychometric analyses, following currently recommended procedures and criteria, were performed to allow for comparison with existing measures. The conceptual framework included six domains: satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being. Independent scales were constructed for these domains. This new patient-reported outcome measure "system" (the BREAST-Q) contains three modules (augmentation, reconstruction, and reduction), each with a preoperative and postoperative version. Each scale fulfilled Rasch and traditional psychometric criteria (including person separation index 0.76 to 0.95; Cronbach's alpha 0.81 to 0.96; and test-retest reproducibility 0.73 to 0.96). The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient's perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.
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              Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures.

              Published data on quality of life in women after breast reconstruction are inconsistent. This cross-sectional study evaluated the quality of life of women after successful breast reconstruction in comparison with those who underwent mastectomy alone.
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                Author and article information

                Contributors
                elisabeth.kappos@usb.ch
                Journal
                Breast Cancer Res Treat
                Breast Cancer Res Treat
                Breast Cancer Research and Treatment
                Springer US (New York )
                0167-6806
                1573-7217
                19 February 2021
                19 February 2021
                2021
                : 187
                : 2
                : 437-446
                Affiliations
                [1 ]GRID grid.410567.1, Breast Center, University Hospital of Basel, ; Spitalstrasse 21, 4031 Basel, Switzerland
                [2 ]GRID grid.6612.3, ISNI 0000 0004 1937 0642, University of Basel, ; Spitalstrasse 21, 4031 Basel, Switzerland
                [3 ]GRID grid.410567.1, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, , University Hospital of Basel, ; Basel, Switzerland
                [4 ]GRID grid.51462.34, ISNI 0000 0001 2171 9952, Breast Surgery Service, , Memorial Sloan Kettering Cancer Center, ; New York, NY USA
                [5 ]Biometrical Practice BIOP, Basel, Switzerland
                [6 ]GRID grid.410567.1, Department of Obstetrics and Gynecology, , University Hospital of Basel, ; Basel, Switzerland
                Author information
                http://orcid.org/0000-0003-4057-1951
                Article
                6126
                10.1007/s10549-021-06126-6
                8189956
                33606158
                ed31725c-c430-41b9-b48e-f80d2c426ea5
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 May 2020
                : 2 February 2021
                Funding
                Funded by: “Freie Akademische Gesellschaft Basel”.
                Funded by: Takeda Pharmaceuticals International
                Funded by: FundRef http://dx.doi.org/10.13039/100008067, Genomic Health;
                Funded by: Novartis Oncology
                Funded by: FundRef http://dx.doi.org/10.13039/100011218, Sandoz;
                Funded by: FundRef http://dx.doi.org/10.13039/100004319, Pfizer;
                Funded by: FundRef http://dx.doi.org/10.13039/100004374, Medtronic;
                Funded by: Universität Basel (Universitätsbibliothek Basel)
                Categories
                Clinical Trial
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Oncology & Radiotherapy
                breast cancer surgery,oncoplastic surgery,quality of life,patient-related outcomes,age,elderly

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