Long-Term Patient-Reported Outcomes in Older Breast Cancer Survivors: A Population-Based Survey Study

Publication date: Available online 9 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Cameron W. Swanick, Xiudong Lei, Ying Xu, Yu Shen, Nathan A. Goodwin, Grace L. Smith, Sharon H. Giordano, Kelly K. Hunt, Reshma Jagsi, Simona F. Shaitelman, Susan K. Peterson, Benjamin D. Smith
PurposeFor older women with breast cancer, local therapy options may include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy (Lump+Brachy), lumpectomy alone (Lump alone), mastectomy without radiation (Mast alone), and mastectomy plus radiation (Mast+RT). We surveyed a population-based cohort of older breast cancer survivors to assess the association of local therapy with long-term quality of life (QOL) outcomes.Methods and MaterialsWe used nationally comprehensive Medicare claims to identify women age ≥67 diagnosed with non-metastatic breast cancer in 2009, treated with 1 of these 5 treatment options, and still alive in 2015. From this cohort, 1650 patients (330 patients per treatment) were randomly selected. Potential participants were mailed a survey that included the CanSORT Satisfaction with Breast Cosmetic Outcome, BREAST-Q, Decisional Regret Scale, and EQ-5D-3L. Multivariable linear regression was used to assess associations between local therapy and outcomes after adjusting for patient, disease, and treatment covariates.ResultsAmong 489 returned surveys (30% response rate), median age was 72 years (range 67-87). Interval from diagnosis to survey completion was approximately 6 years for all patients. Compared to Lump+WBI (adjusted score=3.40), the CanSORT cosmetic satisfaction scores were higher for Lump+Brachy (score=3.77, P=0.007) and Lump alone (score=3.80, P=0.04) and lower for Mast+RT (score=3.01, P=0.006). Similar trends were seen for BREAST-Q cosmetic satisfaction. BREAST-Q psychosocial, sexual, and physical well-being and EQ-5D-3L global health status tended to be better in patients treated with less radiation and less surgery. BREAST-Q adverse radiation effects were worse for Lump+WBI compared to Lump+Brachy. Decisional regret regarding surgery and radiation did not differ across groups. Compared to Lump+WBI, patients treated with Lump+Brachy and Lump alone reported slightly higher rates of in-breast recurrence (excess risk of 5.8% and 6.4%, respectively; P=0.01).ConclusionsIn this nationally diverse cohort, less radiation and less surgery were associated with better long-term QOL outcomes. However, patient regret regarding surgery and radiation therapy was similar across all groups.



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