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Ramos LDSP, Biazús JV. Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo13. [PMID: 38765542 PMCID: PMC11075384 DOI: 10.61622/rbgo/2024ao13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/25/2023] [Indexed: 05/22/2024] Open
Abstract
Objective The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.
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Affiliation(s)
- Lilian de Sá Paz Ramos
- Federal University of Rio Grande do SulPorto AlegreRSBrazilFederal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Jorge Villanova Biazús
- Federal University of Rio Grande do SulPorto AlegreRSBrazilFederal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Park BC, Drolet BC, Perdikis G. Vanderbilt Mini-PROM-Breast for Breast Reconstruction: A Short-Form, Patient-Reported Outcomes Measure. Plast Reconstr Surg 2024; 153:291e-302e. [PMID: 38266134 DOI: 10.1097/prs.0000000000010620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Breast reconstruction procedures are among the most commonly performed plastic surgery operations. Although there are well-validated patient-reported outcomes measures (PROMs) for breast reconstruction, there are several patient-, provider-, and service-level barriers to their implementation in routine clinical settings. Therefore, we developed a short-form PROM to evaluate breast reconstruction outcomes. METHODS Using a mixed-methods approach, the Vanderbilt Mini-PROM-Breast (VMP-B) was constructed and validated to assess patient-reported outcomes from breast reconstruction. Classic test theory methods were used to evaluate acceptability, reliability, and validity. External validation was subsequently performed using the BREAST-Q as a reference standard. RESULTS The VMP-B is a 16-item instrument composed of three domains: quality of life, body image, and breast satisfaction. Psychometric properties including acceptability, reliability, and validity exceeded reference criteria. When tested with 104 patients, the authors found significant benefits of breast reconstruction on quality of life, body image, and breast satisfaction. These results were associated with sizeable effect sizes (g) (g = 0.421, g = 0.520, and g = 1.25) demonstrative of clinically meaningful results. When tested concurrently in 70 patients, the VMP-B and the BREAST-Q showed similar results, exhibiting excellent convergent validity. CONCLUSIONS The VMP-B is a validated short-form PROM that reliably assesses breast reconstruction outcomes. As a short form, the VMP-B decreases both patient and provider burden, which allows for routine, point-of-care collection of breast reconstruction outcomes.
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Affiliation(s)
| | - Brian C Drolet
- Department of Plastic Surgery
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center
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Gümüscü R, Unukovych D, Wärnberg F, de Boniface J, Sund M, Åhsberg K, Hansson E, Folkvaljon F, Mani M. National long-term patient-reported outcomes following mastectomy with or without breast reconstruction: The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2). BJS Open 2024; 8:zrae003. [PMID: 38415759 PMCID: PMC10898865 DOI: 10.1093/bjsopen/zrae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/14/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). The current part (SweBRO 2) is designed to evaluate health-related quality of life (HRQoL), with the hypothesis that BR has a positive impact on patient-reported HRQoL in the long-term. METHODS Women who underwent mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. Eligible participants received formal invitation letters to take part in a survey evaluating their HRQoL at 5 , 10, or 15 years post-mastectomy. The EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-3L questionnaires were employed. RESULTS Of 2904 respondents (50% of 5853 invited), 895 (31%) had received BR. Among them, 516 (58%) were reconstructed with implants and 281 (31%) with autologous tissue. Women with BR scored significantly better in the EORCT QLQ-C30 physical functioning domain (mean 90 versus 81 points), fatigue (mean 21 versus 25), and dyspnoea (mean 16 versus 22) compared to non-reconstructed women. The EORTC QLQ-BR23 revealed that women with BR experienced favourable sexual functioning compared with non-reconstructed women (mean 26 versus 14). The EQ-5D-3L visual analogue scale score was similar between groups. CONCLUSION The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning. These underline the importance of informing women undergoing mastectomy about BR alternatives and its potential benefits in enhancing long-term well-being.
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Affiliation(s)
- Rojda Gümüscü
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Dmytro Unukovych
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Jana de Boniface
- Department of Surgery, Capio S:t Göran’s Hospital, Stockholm, Sweden
- Departement of Medicine and Surgery, Karolinska Intitutet, Stockholm, Sweden
| | - Malin Sund
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristina Åhsberg
- Department of Surgery, Halland Hospital, Halmstad, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic and Reconstructive Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Maria Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden
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Duymus ME, Gumus S. Aesthetic outcomes of breast-conserving surgery and oncoplastic surgery with the new scale named Quality of Life Questionnaire Breast Reconstruction Module-23. Ann Surg Treat Res 2023; 104:249-257. [PMID: 37179696 PMCID: PMC10172031 DOI: 10.4174/astr.2023.104.5.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose Oncoplastic surgery (OPS) has been developed with the aim of improving breast-conserving surgery (BCS) to provide better aesthetic and functional outcomes for breast cancer patients. We aimed to compare overall quality of life (QoL) and satisfaction with breast reconstruction in patients undergoing BCS and OPS using the Quality of Life Questionnaire Core 30 (QLQ-C30) and recently validated QLQ-Breast Reconstruction module (QLQ-BRECON23). Methods A total of 87 patients were included in this single-center study between January 1, 2018 and December 31, 2021; 43 underwent OPS (49.4%) and 44 underwent BCS (50.6%). The data on patient, tumor, and treatment characteristics were obtained from the prospectively collected database at the hospital. QLQ-C30 and QLQ-BRECON23 were used to evaluate psychosocial well-being, fatigue symptoms, overall QoL, sexual well-being, sensation of the operative area, and satisfaction with the reconstruction. Results According to QLQ-C30 evaluation there were significantly better outcomes for patients treated with OPS than BCS in terms of psychosocial well-being, fatigue symptoms, and overall QoL (P = 0.005, P = 0.016, and P = 0.004; respectively), according to QLQ-BRECON23 evaluation there were also significantly better outcomes in terms of sexual well-being, sensation of the operative area, and satisfaction of the reconstruction (P < 0.001, P = 0.002, and P < 0.001; respectively). Conclusion We found that the overall QoL and satisfaction with breast reconstruction in patients undergoing OPS are better than those undergoing BCS. Our study is critical because it is the first study comparing OPS and BCS using the QLQ-BRECON23, which was recently validated.
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Affiliation(s)
- Mehmet Esat Duymus
- Division of Surgical Oncology, Department of General Surgery, Hatay Training and Researcher Hospital, Hatay, Turkey
| | - Serdar Gumus
- Division of Surgical Oncology, Department of General Surgery, Hatay Training and Researcher Hospital, Hatay, Turkey
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5
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Biswas S, Mullikin A, Phillips BT. Trends in Patient-Reported Outcomes Reporting in Breast Reconstruction: A Scoping Literature Review. Ann Plast Surg 2023; 90:501-505. [PMID: 37146316 DOI: 10.1097/sap.0000000000003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) provide essential information in reconstructive surgery, where interventions center on patients' functional and aesthetic goals. Although multiple patient-reported outcome measures (PROMs) have been validated for breast reconstruction since 2009, no studies have assessed recent frequency and consistency in use. This study aims to characterize recent trends in inclusion of PROs in recent breast reconstruction literature. METHODS Articles published between 2015 and 2021 pertaining to autologous and/or prosthetic breast reconstruction in Annals of Plastic Surgery and Journal of Plastic and Reconstructive Surgery were considered in a scoping review. Original breast reconstruction articles were reviewed for use of PROMs and characteristics of administration in accordance with PRISMA-Scr guidelines. Previously defined scoping review criteria were considered, including PROM used, timeline of collection, and topics addressed, with trends in frequency and consistency of usage assessed over the designated period. RESULTS Of the 877 articles reviewed and 232 articles included, 24.6% reported using any PROM. The majority used BREAST-Q (n = 42, 73.7%), with the remainder being institutional surveys or previously validated questionnaires. Patient-reported outcomes were most often collected retrospectively (n = 20, 64.9%) and postoperatively (n = 33, 57.9%). The average time point of postoperative survey administration was 16.03 months (SD, 19.185 months). χ2 Analysis revealed no significant association between the numbers of articles, including PROMs and the year (P = 0.1047). CONCLUSIONS This study demonstrates that only one-fourth of breast reconstruction articles report the use of PROMs with no interval increase over recent years. Patient-reported outcome measures were predominantly used retrospectively and postoperatively with notable variation in timing of administration. The findings highlight the need for improved frequency and consistency of PROM collection and reporting, as well as for further exploration into barriers and facilitators of PROM use.
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Affiliation(s)
- Sonali Biswas
- From the Division of Plastic, Oral, and Maxillofacial Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
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6
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Vieira RADC, Bailão-Junior A, de Oliveira-Junior I. Does breast oncoplastic surgery improve quality of life? Front Oncol 2023; 12:1099125. [PMID: 36713564 PMCID: PMC9877289 DOI: 10.3389/fonc.2022.1099125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Breast Oncoplastic Surgery (OS) has established itself as a safe procedure associated with the treatment of breast cancer, but the term is broad, encompassing procedures associated with breast-conserving surgeries (BCS), conservative mastectomies and fat grafting. Surgeons believe that OS is associated with an increase in quality of life (QOL), but the diversity of QOL questionnaires and therapeutic modalities makes it difficult to assess from the patient's perspective. To answer this question, we performed a search for systematic reviews on QOL associated with different COM procedures, and in their absence, we selected case-control studies, discussing the main results. We observed that: (1) Patients undergoing BCS or breast reconstruction have improved QoL compared to those undergoing mastectomy; (2) In patients undergoing BCS, OS has not yet shown an improvement in QOL, a fact possibly influenced by patient selection bias; (3) In patients undergoing mastectomy with reconstruction, the QoL results are superior when the reconstruction is performed with autologous flaps and when the areola is preserved; (4) Prepectoral implants improves QOL in relation to subpectoral implant-based breast reconstruction; (5) ADM do not improves QOL; (6) In patients undergoing prophylactic mastectomy, satisfaction is high with the indication, but the patient must be informed about the potential complications associated with the procedure; (7) Satisfaction is high after performing fat grafting. It is observed that, in general, OS increases QOL, and when evaluating the procedures, any preservation or repair, or the use of autologous tissues, increases QOL, justifying OS.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Cirurgia Oncológica, Divisão de Mastologia, Hospital de Câncer de Muriaé, Muriaé/MG, Brazil,Active Member of European Organisation for Research and Treatment (EORTC) Quality of life Group, Brussels, Belgium,*Correspondence: René Aloisio da Costa Vieira,
| | - Antônio Bailão-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Botucatu/SP, Brazil,Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos/SP, Brazil,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos/SP, Brazil
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7
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Gold D, Nicolay L, Avian A, Greimel E, Balic M, Pristauz-Telsnigg G, Tamussino K, Trutnovsky G. Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial. Maturitas 2022; 167:1-7. [DOI: 10.1016/j.maturitas.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 07/19/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
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Dalci K, Gumus S, Saritas AG, Gul MO, Rencuzogullari A, Akcam AT, Ulku A, Ergin M, Sakman G. Modified techniques versus Hadfield's procedure in patients with periductal mastitis. BMC Surg 2022; 22:40. [PMID: 35120473 PMCID: PMC8817489 DOI: 10.1186/s12893-022-01496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.
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Affiliation(s)
- Kubilay Dalci
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Serdar Gumus
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey.
| | - Ahmet Gokhan Saritas
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Mehmet Onur Gul
- Department of Surgical Oncology, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Ahmet Rencuzogullari
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Atilgan Tolga Akcam
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Abdullah Ulku
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
| | - Melek Ergin
- Department of Pathology, Cukurova University Adana, Sarıcam, 01330, Adana, Turkey
| | - Gurhan Sakman
- Department of General Surgery, Cukurova University, Sarıcam, 01330, Adana, Turkey
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Lohmander F, Lagergren J, Johansson H, Roy PG, Brandberg Y, Frisell J. Effect of Immediate Implant-Based Breast Reconstruction After Mastectomy With and Without Acellular Dermal Matrix Among Women With Breast Cancer: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127806. [PMID: 34596671 PMCID: PMC8486981 DOI: 10.1001/jamanetworkopen.2021.27806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The use of acellular dermal matrix (ADM) in implant-based breast reconstructions (IBBRs) is established practice. Existing evidence validating ADMs proposed advantages, including improved cosmetics and more single-stage IBBRs, is lacking. OBJECTIVE To evaluate whether IBBR with ADM results in fewer reoperations and increased health-related quality of life (HRQoL) compared with conventional IBBR without ADM. DESIGN, SETTING, AND PARTICIPANTS This was an open-label, multicenter, randomized clinical trial of women with primary breast cancer who planned for mastectomy and immediate IBBR, with a 2-year follow-up for all participants. Participants were enrolled at 5 breast cancer units in Sweden and the United Kingdom between 2014 and May 2017. Exclusion criteria included previous radiotherapy and neo-adjuvant chemotherapy. Data were analyzed until August 2017. INTERVENTIONS Participants were allocated to immediate IBBR with or without ADM. MAIN OUTCOMES AND MEASURES The primary trial end point was number of reoperations at 2 years. HRQoL, a secondary end point, was measured as patient-reported outcome measures using 3 instruments from the European Organization for Research and Treatment of Cancer Quality of life Questionnaire. RESULTS From start of enrollment on April 24, 2014, to close of trial on May 10, 2017, a total of 135 women were enrolled (mean [SD] age, 50.4 [9.5] years); 64 were assigned to have an IBBR procedure with ADM and 65 to the control group who had IBBR without ADM. There was no statistically significant difference between groups for the primary outcome. Of 129 patients analyzed at 2-year follow-up, 44 of 64 (69%) had at least 1 surgical event in the ADM group vs 43 of 65 (66%) in the control group. In the ADM group, 31 patients (48%) had at least 1 reoperation on the ipsilateral side vs 35 (54%) in the control group. The overall number of reoperations on the ipsilateral side were 42 and 43 respectively. Within the follow-up time of 24 months, 9 patients (14%) in the ADM group had the implant removed compared with 7 (11%) in the control group. We found no significant mean differences in postoperative patient-reported HRQoL domains, including perception of body image (mean difference, 3; 99% CI, -11 to 17; P = .57) and satisfaction with cosmetic outcome (mean difference, 8; 99% CI, -6 to 20; P = .11). CONCLUSIONS AND RELEVANCE Immediate IBBR with ADM did not yield fewer reoperations compared with conventional IBBR without ADM, nor was IBBR with ADM superior in terms of HRQoL or patient-reported cosmetic outcomes. Patients treated for breast cancer contemplating ADM-supported IBBR should be informed about the lack of evidence validating ADM's suggested benefits. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02061527.
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Affiliation(s)
- Fredrik Lohmander
- Section of Breast Surgery, Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jakob Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Breast Center, Capio St: Görans Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Pankaj G. Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Patient-reported Outcomes and 3-dimensional Surface Imaging after Risk-reducing Mastectomy and Immediate Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3561. [PMID: 34036021 PMCID: PMC8140769 DOI: 10.1097/gox.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
The cosmetic results after risk-reducing mastectomy (RRM) and immediate breast reconstruction (IBR) are intended to be long-lasting. Long-term follow-up of the cosmetic outcome can be evaluated subjectively by the women themselves through patient-reported outcome measures such as questionnaires, or by using data from three-dimensional surface imaging (3D-SI) to calculate the volume, shape, and symmetry of the reconstructed breasts as a more objective cosmetic evaluation. The study aim was to evaluate the correspondence between patient-reported measures and 3D-SI measurements.
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11
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Domenici L, Caputo GG, Losco L, Di Taranto G, Lo Torto F, Pierazzi DM, Governa M, Benedetti Panici P, Ribuffo D, Cigna E. Muscle-Sparing Skin-Reducing Breast Reconstruction with Pre-Pectoral Implants in Breast Cancer Patients: Long-Term Assessment of Patients' Satisfaction and Quality of Life. J INVEST SURG 2021; 35:841-847. [PMID: 34015977 DOI: 10.1080/08941939.2021.1923874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Breast cancer is the most frequently diagnosed tumor in women; globally, it accounts 23% of all cancer deaths. Breast reconstruction after oncologic surgery has become crucial to enhance patients' quality of life and alleviate the psychological distress related to the disease. The aim of this study was to assess quality of life and esthetic satisfaction of breast cancer patients undergoing muscle-sparing skin-reducing breast reconstruction (MS-SR) with pre-pectoral implants. METHODS Sixty-three patients who met definite oncological and reconstructive criteria were enrolled in the study. Specific questionnaires (EORTC QLQ-C30, QLQ-BR23) were administered preoperatively, 1, and 12 months after MS-SR breast reconstruction to evaluate patients' QoL. Satisfaction with procedure and related Quality of Life were assessed through BREAST-Q questionnaire preoperatively and 12 months after surgery. RESULTS Sixty-three breast cancer patients underwent MS-SR. Seventy-eight procedures were carried out; in 15 patients a bilateral reconstruction was performed. One month after surgery, both EORTC QLQ-C30 and QLQ-BR23 average scores demonstrated a slight drop since preoperative values, but a significant improvement in QoL was documented 12 months after BR (p < 0.05). BREAST-Q test showed significant psychophysical and esthetic satisfaction 12 months postoperatively. CONCLUSIONS Muscle-sparing skin-reducing breast reconstruction is an established and reliable technique. EORTC QLQ-C30, QLQ-BR23 and BREAST-Q scores showed an improvement of patients' QoL and esthetic satisfaction. Reduction of pain and other surgery-related symptoms are cornerstones of patient well-being. Both physicians and patients should build a thorough awareness of the silver lining of muscle-sparing skin-reducing breast reconstruction based on the high safety profile and highly satisfactory patient-reported results.
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12
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Davies CF, Macefield R, Avery K, Blazeby JM, Potter S. Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties. Ann Surg Oncol 2021; 28:386-404. [PMID: 32602063 PMCID: PMC7752876 DOI: 10.1245/s10434-020-08736-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Breast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies. METHODS A PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach. RESULTS Fourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality. CONCLUSIONS BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.
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Affiliation(s)
- C F Davies
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.
| | - R Macefield
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - K Avery
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- University Hospitals Bristol Foundation NHS Trust, Bristol, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Bok SK, Song Y, Lim A, Choi H, Shin H, Jin S. Korean Translation and Psychometric Evaluation of Korean Version EORTC QLQ-BRECON23. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249163. [PMID: 33302470 PMCID: PMC7763321 DOI: 10.3390/ijerph17249163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer Quality of Life-QLQ-BRECON23 in women diagnosed and treated for breast cancer undergoing all types of breast reconstruction. Methods: A total of 148 Korean women who underwent breast reconstruction were recruited from the breast cancer center to participate in the study. After performing forward and backward translation of the original English version of the questionnaire into Korean, its validity (construct, known-group validity, concurrent) and reliability were assessed. A structural equation model (SEM) was used to assess construct validity. Results: The mean age of the patients was 52 years, and 89.8% underwent implant-based reconstruction. Construct validity using confirmatory factor analysis showed a good fit, and the effect size was small-to-medium regarding known-group validity. Concurrent validity was confirmed by the significant correlation between the QLQ-BRECON23 and the QLQ-BR23. The reliability of the QLQ-BRECON23 symptom and function scales ranged from 0.61 to 0.87. Conclusion: The Korean QLQ-BRECON23 can be applied to assess quality of life and its related factors, and also to internationally compare the level of quality of life in breast cancer patients undergoing breast reconstruction.
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Affiliation(s)
- Soo-Kyung Bok
- College of Medicine, Chungnam National University, Daejeon 35015, Korea;
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (H.C.); (H.S.); (S.J.)
- Correspondence: (Y.S.); (A.L.)
| | - Ancho Lim
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (H.C.); (H.S.); (S.J.)
- Correspondence: (Y.S.); (A.L.)
| | - Hyunsuk Choi
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (H.C.); (H.S.); (S.J.)
| | - Hyunkyung Shin
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (H.C.); (H.S.); (S.J.)
| | - Sohyun Jin
- College of Nursing, Chungnam National University, Daejeon 35015, Korea; (H.C.); (H.S.); (S.J.)
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14
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van de Voort EMF, Klem TMAL, Struik GM, Birnie E, Sinke RHJA, Ghandi A. Patient reported cosmetic outcome after vacuum assisted excision of benign breast lesions: a cross-sectional study. Br J Radiol 2020; 93:20190994. [PMID: 32649240 DOI: 10.1259/bjr.20190994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Better cosmetic outcome after vacuum assisted excision (VAE) compared to surgical excision of benign breast lesions is suggested in previous studies but has never been evaluated with validated outcome measures. In this study, patient reported cosmetic outcome after VAE was evaluated. METHODS Patients who underwent VAE between July 2017 and December 2018 were invited to complete the cosmetic subscale of the Dutch Breast Cancer Treatment Outcome Scale, comparing the treated with the untreated breast. Response mode ranged from 1 (no difference) to 4 (large difference) and cosmetic outcome was calculated as the unweighted mean. Clinical outcomes included: tumor size, number of cores, complications, residual lesions and recurrences. RESULTS Response rate was 73.4% (47 of 64 patients). Median tumor size was 15 mm (range 5-51 mm) and median number of cores 6.5 (range 1-85), complete excision was confirmed in all but two patients. Mean cosmetic outcome was good (mean score ≤1.75) in 74% of patients and no patients reported a poor cosmetic outcome (mean score >3.25). A hematoma occurred in five patients (one needed aspiration) and a skin rash in one patient, no patients developed an infection or seroma. CONCLUSION In this study VAE is safe and effective for tumors up to 5 cm and patient reported cosmetic outcome was good. Patients with benign lesions could benefit from VAE as an alternative for surgical excision. ADVANCES IN KNOWLEDGE A formal quantitative measurement of cosmetic outcome after vacuum assisted excision for benign breast lesions was still lacking. This study shows that this cosmetic outcome is overall good in benign lesions up to 5 cm.
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Affiliation(s)
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.,Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.,Department of Genetics, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Renata H J A Sinke
- Department of Pathology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Ali Ghandi
- Department of Radiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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15
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Khajuria A, Charles WN, Prokopenko M, Beswick A, Pusic AL, Mosahebi A, Dodwell DJ, Winters ZE. Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes. BJS Open 2020; 4:182-196. [PMID: 32207573 PMCID: PMC7093792 DOI: 10.1002/bjs5.50245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effects of postmastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial regarding surgical complications, cosmetic appearance and quality of life (QOL). This systematic review evaluated these outcomes after abdominal free flap reconstruction in patients undergoing postoperative adjuvant radiotherapy (PMRT), preoperative radiotherapy (neoadjuvant radiotherapy) and no radiotherapy, aiming to establish evidence-based optimal timings for radiotherapy and BRR to guide contemporary management. METHODS The study was registered on PROSPERO (CRD42017077945). Embase, MEDLINE, Google Scholar, CENTRAL, Science Citation Index and ClinicalTrials.gov were searched (January 2000 to August 2018). Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I respectively. RESULTS Some 12 studies were identified, involving 1756 patients (350 PMRT, 683 no radiotherapy and 723 neoadjuvant radiotherapy), with a mean follow-up of 27·1 (range 12·0-54·0) months for those having PMRT, 16·8 (1·0-50·3) months for neoadjuvant radiotherapy, and 18·3 (1·0-48·7) months for no radiotherapy. Three prospective and nine retrospective cohorts were included. There were no randomized studies. Five comparative radiotherapy studies evaluated PMRT and four assessed neoadjuvant radiotherapy. Studies were of low quality, with moderate to serious risk of bias. Severe complications were similar between the groups: PMRT versus no radiotherapy (92 versus 141 patients respectively; odds ratio (OR) 2·35, 95 per cent c.i. 0·63 to 8·81, P = 0·200); neoadjuvant radiotherapy versus no radiotherapy (180 versus 392 patients; OR 1·24, 0·76 to 2·04, P = 0·390); and combined PMRT plus neoadjuvant radiotherapy versus no radiotherapy (272 versus 453 patients; OR 1·38, 0·83 to 2·32, P = 0·220). QOL and cosmetic studies used inconsistent methodologies. CONCLUSION Evidence is conflicting and study quality was poor, limiting recommendations for the timing of autologous BRR and radiotherapy. The impact of PMRT and neoadjuvant radiotherapy appeared to be similar.
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Affiliation(s)
- A. Khajuria
- Kellogg College, Nuffield Department of SurgeryUniversity of OxfordOxfordUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - W. N. Charles
- Department of Surgery and CancerImperial College LondonLondonUK
| | - M. Prokopenko
- Department of Plastic SurgeryRoyal Free HospitalLondonUK
| | - A. Beswick
- School of Clinical SciencesUniversity of BristolBristolUK
| | - A. L. Pusic
- Patient‐Reported Outcomes, Value and Experience Centre, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - A. Mosahebi
- Department of Plastic SurgeryRoyal Free HospitalLondonUK
| | - D. J. Dodwell
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Z. E. Winters
- Surgical Intervention Trials Unit, Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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16
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Bjelic-Radisic V, Cardoso F, Cameron D, Brain E, Kuljanic K, da Costa RA, Conroy T, Inwald EC, Serpentini S, Pinto M, Weis J, Morag O, Lindviksmoen Astrup G, Tomaszweksi KA, Pogoda K, Sinai P, Sprangers M, Aaronson N, Velikova G, Greimel E, Arraras J, Bottomley A. An international update of the EORTC questionnaire for assessing quality of life in breast cancer patients: EORTC QLQ-BR45. Ann Oncol 2019; 31:283-288. [PMID: 31959345 DOI: 10.1016/j.annonc.2019.10.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23 was one of the first disease-specific questionnaires developed in 1996 to assess quality of life (QoL) in patients with breast cancer (BC). However, since 1996 major changes in BC treatment have occurred, requiring an update of the EORTC BC module. This study presents the results of the phase I-III update of the QLQ-BR23 questionnaire. PATIENTS AND METHODS The update of the EORTC QLQ-BR23 module followed standard EORTC guidelines. A systematic literature review revealed 83 potential relevant QoL issues during phases I and II. After shortening the issues list and following interviews with patients and health care providers, 15 relevant issues were transformed into 27 items. The preliminary module was pretested in an international, multicentre phase III study to identify and solve potential problems with wording comprehensibility and acceptability of the items. Descriptive statistics are provided. Analyses were qualitative and quantitative. We provide a psychometric structure of the items. RESULTS The phase I and II results indicated the need to supplement the original QLQ-BR23 with additional items related to newer therapeutic options. The phase III study recruited a total of 250 patients (from 12 countries). The final updated phase III module contains a total of 45 items: 23 items from the QLQ-BR23 and 22 new items. The new items contain two multi-item scales: a target symptom scale and a satisfaction scale. The target symptom scale can be divided into three subscales: endocrine therapy, endocrine sexual and skin/mucosa scale. CONCLUSION Our work has led to the development of a new EORTC QLQ-BR45 module that provides a more accurate and comprehensive assessment of the impact of new and scalable treatments on patients' QoL. The final version of the EORTC QLQ-BR45 is currently available for use in clinical practice. The final phase IV study is underway to confirm psychometric properties of the module.
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Affiliation(s)
- V Bjelic-Radisic
- Breast Unit, Helios University Clinic, University Witten/Herdecke, Wuppertal, Germany.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - D Cameron
- Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - E Brain
- Department of Medical Oncology Institute Curie - Hôpital René Huguenin, Saint-Cloud, France
| | - K Kuljanic
- Department of Obstetrics and Gynecology, Clinical Center Rijeka, Rijeka, Croatia
| | - R A da Costa
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil
| | - T Conroy
- Department of Medical Oncology, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - E C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - S Serpentini
- Unit for Psychooncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Pinto
- National Tumor Institute, Instituto Nazionale Tumori Fondazione Pascale Naples, Naples, Italy
| | - J Weis
- Comprehensive Cancer Center, Medical Faculty, University Medical Center Freiburg, Freiburg, Germany
| | - O Morag
- Unit Pain Clinic, Sheba - Tel Ha Shomer Hospital, Tel Aviv, Israel
| | | | - K A Tomaszweksi
- Department of Surgery, Jagillonian University Medical College Krakow, Krakow, Poland
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - P Sinai
- Southmead Hospital, University of Bristol, Bristol, UK
| | - M Sprangers
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - N Aaronson
- Department of Psychosocial Research, NKI Netherlands, Amsterdam, The Netherlands
| | - G Velikova
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - E Greimel
- Department of Gynecology and Obstetrics, Medical University Graz, Graz, Austria
| | - J Arraras
- Oncology Department, Hospital of Navarre, Pamplona, Spain
| | - A Bottomley
- EORTC HQ, Quality of Life Department, Brussels, Belgium
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A Meta-analysis of Clinical, Patient-Reported Outcomes and Cost of DIEP versus Implant-based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2486. [PMID: 31772906 PMCID: PMC6846300 DOI: 10.1097/gox.0000000000002486] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/16/2019] [Indexed: 02/06/2023]
Abstract
Comparative data on clinical outcomes and cost of deep inferior epigastric perforator (DIEP) and implant-based reconstruction (IBR) are limited. We conducted a Preferred Reporting Items for Systematic Review and Meta-analysis-compliant systematic review and meta-analysis to compare clinical, patient-reported outcomes (PROs) and cost.
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18
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Church J. Quality of life and patient-reported outcomes. Br J Surg 2018; 105:157-158. [PMID: 29405272 DOI: 10.1002/bjs.10824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023]
Abstract
The lay view
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Affiliation(s)
- J Church
- Patient Liaison Group, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
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19
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Winters ZE, Khajuria A. Quality of life after breast reconstruction-the BRIOS study. Lancet Oncol 2018; 19:e579. [PMID: 30507482 DOI: 10.1016/s1470-2045(18)30709-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Zoë E Winters
- Surgical & Interventional Trials Unit (SITU), Division of Surgery & Interventional Science, University College London, London, W1W 7JN, UK.
| | - Ankur Khajuria
- Kellogg College, Department of Continuing Education, University of Oxford, Oxford, UK; Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Struik GM, de Jongh FW, Birnie E, Pignol JP, Klem TM. Development and psychometric evaluation of a Dutch-translated shorter Breast Cancer Treatment Outcome Scale (Dutch BCTOS-13). J Patient Rep Outcomes 2018; 2:60. [PMID: 30543030 PMCID: PMC6291412 DOI: 10.1186/s41687-018-0085-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To create a Dutch translated short version of the Breast Cancer Treatment Outcome Scale (BCTOS) and validate it in patients who have completed both breast conserving surgery and adjuvant radiotherapy. METHODS The BCTOS consists of items comparing the treated with the untreated breast. After forward and backward translation, we tested the BCTOS-12 plus 5 additional items. Two-hundred breast cancer patients treated with breast conserving therapy (BCT) between January 2016 and December 2017, were asked to complete the BCTOS items twice with a 2 week interval. The EORTC QLQ-BR23 breast and arm symptoms subscales were completed once in parallel. Feasibility was assessed by missing or non-unique answer rates and content validity with floor and ceiling effect analysis. Construct validity was evaluated with 1) principal component analysis (PCA) 2) convergent validity and 3) known groups comparison (clinical validity differentiating between patients with and without locoregional side effects). From all potential items with good feasibility, content and construct validity, items were selected for the Dutch BCTOS based on clinical validity. The relation to the EORTC QLQ-BR23 subscales and reliability was tested for the new Dutch BCTOS. RESULTS Hundred and one of 200 (50.5%) approached patients participated in this study, with follow-up after surgery ranging from 5 to 29 months. Feasibility was high (1.5% missing answers). Content validity testing showed a floor effect > 20% in all 17 items. PCA showed that all items loaded well (> 0.4) into the assigned subscale and revealed two distinct subscales: cosmesis and function. Based on clinical validity, item "breast shape" was replaced by "breast elevation/position" and "overall skin appearance". Very good clinical validity (Cohen's d = 1.38) was found for the new Dutch BCTOS-13. Correlation to the EORTC QLQ-BR23 subscales was high (ICC = 0.65-0.85) for both subscales. Test-retest reliability (Cohen's d = 0.105) and internal consistency (Cronbach's α =0.90) were excellent. CONCLUSIONS Psychometric evaluation of a newly developed Dutch BCTOS-13 questionnaire in BCT patients showed excellent results, that were slightly better than the original BCTOS-22 and the shortened BCTOS-12. The good clinical validity makes the BCTOS-13 a useful tool to identify patients with unfavourable cosmetic and functional outcomes, requiring specific attention.
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Affiliation(s)
- Gerson M. Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Radiation Oncology, Erasmus MC - Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Frank W. de Jongh
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
- Department of Genetics, UMC Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus MC - Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands
- Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS B3H1V7 Canada
| | - Taco M. Klem
- Department of Surgery, Franciscus Gasthuis and Vlietland, PO Box 10900, 3004 BA Rotterdam, The Netherlands
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21
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Winters ZE, Bernaudo L. Evaluating the current evidence to support therapeutic mammoplasty or breast-conserving surgery as an alternative to mastectomy in the treatment of multifocal and multicentric breast cancers. Gland Surg 2018; 7:525-535. [PMID: 30687626 DOI: 10.21037/gs.2018.07.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The oncological safety of treating multiple ipsilateral breast cancers (MIBCs) with types of breast conserving surgery (BCS) compared to mastectomy remains uncertain. This is predicated on the absence of any randomised controlled trials or high-quality protocol defined prospective cohort studies. A single recently published systematic review by the first author, reports its summarised results in this review. Fundamentally the important question is the evaluation of clinical safety following BCS compared to mastectomy for treating MIBC, which is reported in only six studies. Consequently, current evidence doesn't support the latest St Gallen consensus suggesting the possibility of using BCS to treat all MIBC. There is minimal comparative outcomes data on multicentric (MC) cancers compared to multifocal (MF) cancers comparing BCS or mastectomy. There is also poor evidence of clinical outcomes following therapeutic mammoplasty (TM) for MIBC compared to mastectomy. The potential recommendation of two potential radiotherapy boosts to separate lumpectomy sites following BCS for MC cancers remains a novel treatment concept whose feasibility will be evaluated in the forthcoming NIHR funded randomised feasibility trial called MIAMI. This is a world first attempt to assess the feasibility of a randomised trial design alongside the on-going Alliance registry study (ACOSOG, American College of Surgeons Oncology Group Z11102) in the USA, in which there is no comparative evaluation of mastectomy outcomes. The MIAMI trial aims to assess the clinical safety of multiple lumpectomies combined with TM compared to the standard of mastectomy in MIBC stratified by MF or MC cancers. There is limited evidence on the impacts of inter-tumoral heterogeneity relating to breast cancer subtypes in relation to individualised treatments and recommendations for types of breast surgery. Recent studies have highlighted the potential contributions of stromal epigenetic changes that are currently poorly understood regarding their contributions to either clinical unifocal or MF cancers.
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Affiliation(s)
- Zoe Ellen Winters
- Breast Cancer Surgery, Patient-Centred and Clinical Outcomes Research Group, Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
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22
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Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat 2018; 172:523-537. [PMID: 30182349 PMCID: PMC6245050 DOI: 10.1007/s10549-018-4937-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
Abstract
Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques. Electronic supplementary material The online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.
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23
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Winters ZE, Benson JR. Surgical treatment of multiple ipsilateral breast cancers. Br J Surg 2018; 105:466-468. [DOI: 10.1002/bjs.10738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/03/2023]
Abstract
Abundant research
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Affiliation(s)
- Z E Winters
- Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, 1 Euston Square, 40 Melton Street, London NW1 2FD, UK
| | - J R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK
- School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
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