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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2023

03-02-2023 | Mastectomy | Breast Oncology

Timing of Chemotherapy and Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Immediate Reconstruction

Authors: Kate R. Pawloski, MD, MPH, Marissa K. Srour, MD, Tracy-Ann Moo, MD, Varadan Sevilimedu, MBBS, DrPH, Jonas A. Nelson, MD, MPH, Paula Garcia, MHA, Laurie J. Kirstein, MD, Monica Morrow, MD, Audree B. Tadros, MD, MPH

Published in: Annals of Surgical Oncology | Issue 5/2023

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Abstract

Introduction

Receipt of chemotherapy is associated with decreased satisfaction after breast surgery, but whether timing as adjuvant versus neoadjuvant (NAC) affects patient-reported outcomes (PROs) is unclear. We examined associations between chemotherapy timing and PROs after breast-conserving surgery (BCS) and mastectomy with immediate reconstruction (M-IR).

Methods

In this retrospective cohort study of patients with stage I-III breast cancer undergoing chemotherapy between January 2017 and December 2019, we compared satisfaction with breasts (SABTR) and chest physical well-being (PWB-CHEST) between chemotherapy groups in BCS and M-IR cohorts. Median SABTR and PWB-CHEST scores (scale 0–100) were compared between chemotherapy groups at baseline and for 3 years postoperatively. Factors associated with SABTR and PWB-CHEST at 1 and 2 years were assessed with multivariable linear regression.

Results

Overall, 640 patients had BCS and 602 had M-IR; 210 (33%) BCS patients and 294 (49%) M-IR patients had NAC. Following BCS, SABTR was higher than baseline at all postoperative timepoints, whereas 3-year SABTR remained similar to baseline following M-IR, independent of chemotherapy timing. In both surgical cohorts, PWB-CHEST was lowest after NAC at 6 months compared with baseline but was similar to adjuvant counterparts by 3 years. NAC was not a statistically significant predictor of SABTR or PWB-CHEST in either surgical cohort on multivariable analysis.

Conclusions

For patients with breast cancer who require chemotherapy, neoadjuvant versus adjuvant timing does not impact long-term PROs in this study. These findings may inform shared decision making regarding the sequence of treatment in patients with operable disease.
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Metadata
Title
Timing of Chemotherapy and Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Immediate Reconstruction
Authors
Kate R. Pawloski, MD, MPH
Marissa K. Srour, MD
Tracy-Ann Moo, MD
Varadan Sevilimedu, MBBS, DrPH
Jonas A. Nelson, MD, MPH
Paula Garcia, MHA
Laurie J. Kirstein, MD
Monica Morrow, MD
Audree B. Tadros, MD, MPH
Publication date
03-02-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13148-5

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