Skip to main content
Top
Published in: Annals of Surgical Oncology 2/2015

01-02-2015 | Breast Oncology

A National Snapshot of Satisfaction with Breast Cancer Procedures

Authors: Dunya M. Atisha, MD, Christel N. Rushing, MS, Gregory P. Samsa, PhD, Tracie D. Locklear, PhD, Charlie E. Cox, MD, E. Shelley Hwang, MD, MPH, Michael R. Zenn, MD, Andrea L. Pusic, MD, MPH, Amy P. Abernethy, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2015

Login to get access

Abstract

Purpose

Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health.

Methods

Women recruited from the Army of Women with a history of breast cancer surgery took electronically administered surgery-specific surveys, including the BREAST-Q© and a background survey evaluating patient-, disease-, and procedure-specific factors. Descriptive statistics and regression analysis were used to evaluate the effect of procedure type on breast satisfaction scores.

Results

Overall, 7,619 women completed the questionnaires. Linear regression revealed that women who underwent abdominal flap, or buttock or thigh flap reconstruction reported the highest breast satisfaction score, scoring an average of 5.6 points and 14.4 points higher than BCS, respectively (p < 0.0001 and p = 0.027, respectively). No difference in satisfaction was observed in women who underwent latissimus dorsi flap reconstruction compared with those who underwent BCS. Women who underwent implant reconstruction reported scores 8.6 points lower than BCS (p < 0.0001). Those with mastectomies without reconstruction or complex surgical histories scored, on average, 10 points lower than BCS (p < 0.0001).

Conclusion

Women who underwent autologous tissue reconstruction reported the highest breast satisfaction, while women undergoing mastectomy without reconstruction reported the lowest satisfaction. These findings emphasize the value of patient-reported outcome measures as an important guide to decision making in breast surgery and underscore the importance of multidisciplinary participation early in the surgical decision-making process.
Literature
1.
go back to reference Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg. 2008;247:1019–28.PubMedCrossRef Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Ann Surg. 2008;247:1019–28.PubMedCrossRef
2.
go back to reference Janz NK, Mujahid M, Lantz PM, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14:1467–79.PubMedCrossRef Janz NK, Mujahid M, Lantz PM, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res. 2005;14:1467–79.PubMedCrossRef
3.
go back to reference Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. Breast. 2007;16:396–410.PubMedCrossRef Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. Breast. 2007;16:396–410.PubMedCrossRef
4.
go back to reference Sackey H, Sandelin K, Frisell J, Wickman M, Brandberg Y. Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image. Eur J Surg Oncol. 2010;36:756–62.PubMedCrossRef Sackey H, Sandelin K, Frisell J, Wickman M, Brandberg Y. Ductal carcinoma in situ of the breast. Long-term follow-up of health-related quality of life, emotional reactions and body image. Eur J Surg Oncol. 2010;36:756–62.PubMedCrossRef
5.
go back to reference Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery. 2008;143:414–25.PubMedCrossRef Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery. 2008;143:414–25.PubMedCrossRef
6.
go back to reference Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106:1014–25; discussion 1026–1017.PubMedCrossRef Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106:1014–25; discussion 1026–1017.PubMedCrossRef
7.
go back to reference Aaronson N, Alonso J, Burnam A, et al. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11:193–205.PubMedCrossRef Aaronson N, Alonso J, Burnam A, et al. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11:193–205.PubMedCrossRef
9.
go back to reference Atisha DM, Locklear TD, Rogers UA, Rushing CN, Samsa GP, Abernethy AP. Partnering with engaged patients accelerates research. J Surg Oncol. 2014;109:504–5.PubMedCrossRef Atisha DM, Locklear TD, Rogers UA, Rushing CN, Samsa GP, Abernethy AP. Partnering with engaged patients accelerates research. J Surg Oncol. 2014;109:504–5.PubMedCrossRef
10.
go back to reference Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129:293–302.PubMedCrossRef Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129:293–302.PubMedCrossRef
11.
go back to reference Cano SJ, Klassen AF, Scott AM, Pusic AL. A closer look at the BREAST-Q©. Clin Plast Surg. 2013;40:287–96.PubMedCrossRef Cano SJ, Klassen AF, Scott AM, Pusic AL. A closer look at the BREAST-Q©. Clin Plast Surg. 2013;40:287–96.PubMedCrossRef
12.
go back to reference Cano SJ Klassen AF, Pusic AL. From BREAST-Q© to Q-Score©: using Rasch measurement to better capture breast surgery outcomes. Presented at the Joint International IMEDO TCI + TC7 + TC13 Symposium, 31 Aug–2 Sept 2011, Jena. Cano SJ Klassen AF, Pusic AL. From BREAST-Q© to Q-Score©: using Rasch measurement to better capture breast surgery outcomes. Presented at the Joint International IMEDO TCI + TC7 + TC13 Symposium, 31 Aug–2 Sept 2011, Jena.
13.
go back to reference Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–53.PubMedCrossRef Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–53.PubMedCrossRef
14.
go back to reference Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res. 2004;4:581–5.PubMedCrossRef Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res. 2004;4:581–5.PubMedCrossRef
15.
go back to reference Hu ES, Pusic AL, Waljee JF, et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009;124:1–8.PubMedCrossRef Hu ES, Pusic AL, Waljee JF, et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period. Plast Reconstr Surg. 2009;124:1–8.PubMedCrossRef
16.
go back to reference McCarthy CM, Klassen AF, Cano SJ, et al. Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants. Cancer. 2010;116:5584–91.PubMedCrossRef McCarthy CM, Klassen AF, Cano SJ, et al. Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants. Cancer. 2010;116:5584–91.PubMedCrossRef
17.
go back to reference Zhong T, McCarthy C, Min S, et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer. 2012;118:1701–9.PubMedCrossRef Zhong T, McCarthy C, Min S, et al. Patient satisfaction and health-related quality of life after autologous tissue breast reconstruction: a prospective analysis of early postoperative outcomes. Cancer. 2012;118:1701–9.PubMedCrossRef
18.
go back to reference Alderman AK, Wilkins EG, Lowery JC, Kim M, Davis JA. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg. 2000;106:769–76.PubMedCrossRef Alderman AK, Wilkins EG, Lowery JC, Kim M, Davis JA. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg. 2000;106:769–76.PubMedCrossRef
19.
go back to reference Eberlein TJ, Crespo LD, Smith BL, Hergrueter CA, Douville L, Eriksson E. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg. 1993;218:29–36.PubMedCentralPubMedCrossRef Eberlein TJ, Crespo LD, Smith BL, Hergrueter CA, Douville L, Eriksson E. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg. 1993;218:29–36.PubMedCentralPubMedCrossRef
20.
go back to reference Hidalgo DA. Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer. Plast Reconstr Surg. 1998;102:63–70; discussion 71–72.PubMedCrossRef Hidalgo DA. Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer. Plast Reconstr Surg. 1998;102:63–70; discussion 71–72.PubMedCrossRef
21.
go back to reference Kroll SS, Baldwin B. A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg. 1992;90:455–62.PubMedCrossRef Kroll SS, Baldwin B. A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg. 1992;90:455–62.PubMedCrossRef
22.
go back to reference Kroll SS, Coffey JA Jr, Winn RJ, Schusterman MA. A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions. Plast Reconstr Surg. 1995;96:860–4.PubMedCrossRef Kroll SS, Coffey JA Jr, Winn RJ, Schusterman MA. A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions. Plast Reconstr Surg. 1995;96:860–4.PubMedCrossRef
23.
go back to reference Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg. 1998;102:49–62.PubMedCrossRef Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg. 1998;102:49–62.PubMedCrossRef
24.
go back to reference Hernanz F, Sanchez S, Cerdeira MP, Figuero CR. Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap. World J Surg Oncol. 2011;9:159.PubMedCentralPubMedCrossRef Hernanz F, Sanchez S, Cerdeira MP, Figuero CR. Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap. World J Surg Oncol. 2011;9:159.PubMedCentralPubMedCrossRef
25.
go back to reference Lantz PM, Janz NK, Fagerlin A, et al. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005;40:745–67.PubMedCentralPubMedCrossRef Lantz PM, Janz NK, Fagerlin A, et al. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005;40:745–67.PubMedCentralPubMedCrossRef
26.
go back to reference Tracy MS, Rosenberg SM, Dominici L, Partridge AH. Contralateral prophylactic mastectomy in women with breast cancer: trends, predictors, and areas for future research. Breast Cancer Res Treat. 2013;140(3):447–52.PubMedCrossRef Tracy MS, Rosenberg SM, Dominici L, Partridge AH. Contralateral prophylactic mastectomy in women with breast cancer: trends, predictors, and areas for future research. Breast Cancer Res Treat. 2013;140(3):447–52.PubMedCrossRef
27.
go back to reference Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.PubMedCrossRef Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.PubMedCrossRef
28.
go back to reference Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.PubMedCrossRef Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7.PubMedCrossRef
29.
go back to reference Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17(10):2554–62.PubMedCrossRef Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998–2007. Ann Surg Oncol. 2010;17(10):2554–62.PubMedCrossRef
30.
go back to reference Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180(6):439–45.PubMedCrossRef Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180(6):439–45.PubMedCrossRef
31.
go back to reference McLaughlin CC, Lillquist PP, Edge SB. Surveillance of prophylactic mastectomy: trends in use from 1995 to 2005. Cancer. 2009;115(23):5404–12.PubMedCrossRef McLaughlin CC, Lillquist PP, Edge SB. Surveillance of prophylactic mastectomy: trends in use from 1995 to 2005. Cancer. 2009;115(23):5404–12.PubMedCrossRef
33.
go back to reference Nekhlyudov L, Bower M, Herrinton LJ, Altschuler A, Greene SM, Rolnick S, et al. Women’s decision-making roles regarding contralateral prophylacti mastectomy. J Natl Cancer Inst Monogr. 2005;35:55–60.PubMedCrossRef Nekhlyudov L, Bower M, Herrinton LJ, Altschuler A, Greene SM, Rolnick S, et al. Women’s decision-making roles regarding contralateral prophylacti mastectomy. J Natl Cancer Inst Monogr. 2005;35:55–60.PubMedCrossRef
34.
go back to reference Gopie JP, Hilhorst MT, Kleijne A, Timman R, Menke-Pluymers MB, Hofer SO, et al. Women’s motives to opt for either implant or DIEP flap breast reconstruction. J Plast Reconstr Surg. 2011;124(6): 1781–9. Gopie JP, Hilhorst MT, Kleijne A, Timman R, Menke-Pluymers MB, Hofer SO, et al. Women’s motives to opt for either implant or DIEP flap breast reconstruction. J Plast Reconstr Surg. 2011;124(6): 1781–9.
35.
go back to reference Lin C, Zhunag Y, Momeni A, Luan J, Chung M, Wright E, et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient reported outcomes instrument Breast-Q. Breast Cancer Res Treat. 2014;146(1):117–26.CrossRef Lin C, Zhunag Y, Momeni A, Luan J, Chung M, Wright E, et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient reported outcomes instrument Breast-Q. Breast Cancer Res Treat. 2014;146(1):117–26.CrossRef
36.
go back to reference Rosenberg SM, Tracy M, Meyer ME, Sepucha K, Gelber S, Hirschfield Bartek J, et al. (2013) Perceptions, knowledge and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med.;159(6):373–81.PubMedCentralPubMedCrossRef Rosenberg SM, Tracy M, Meyer ME, Sepucha K, Gelber S, Hirschfield Bartek J, et al. (2013) Perceptions, knowledge and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med.;159(6):373–81.PubMedCentralPubMedCrossRef
37.
go back to reference Hernanz F, Regano S, Redondo-Figuero C, Orallo V, Erasun F, Gomez Fleitas M. Oncoplastic breast-conserving surgery: analysis of quadrantectomy and immediate reconstruction with latissimus dorsi flap. World J Surg. 2007;31:1934–40.PubMedCrossRef Hernanz F, Regano S, Redondo-Figuero C, Orallo V, Erasun F, Gomez Fleitas M. Oncoplastic breast-conserving surgery: analysis of quadrantectomy and immediate reconstruction with latissimus dorsi flap. World J Surg. 2007;31:1934–40.PubMedCrossRef
38.
go back to reference Denewer A, Setit A, Hussein O, Farouk O. Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap. World J Surg. 2008;32:2586–92.PubMedCrossRef Denewer A, Setit A, Hussein O, Farouk O. Skin-sparing mastectomy with immediate breast reconstruction by a new modification of extended latissimus dorsi myocutaneous flap. World J Surg. 2008;32:2586–92.PubMedCrossRef
39.
go back to reference Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg. 2009;249(3):461–8.PubMedCrossRef Gerber B, Krause A, Dieterich M, Kundt G, Reimer T. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg. 2009;249(3):461–8.PubMedCrossRef
Metadata
Title
A National Snapshot of Satisfaction with Breast Cancer Procedures
Authors
Dunya M. Atisha, MD
Christel N. Rushing, MS
Gregory P. Samsa, PhD
Tracie D. Locklear, PhD
Charlie E. Cox, MD
E. Shelley Hwang, MD, MPH
Michael R. Zenn, MD
Andrea L. Pusic, MD, MPH
Amy P. Abernethy, MD, PhD
Publication date
01-02-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4246-9

Other articles of this Issue 2/2015

Annals of Surgical Oncology 2/2015 Go to the issue