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An Interim Analysis Health Related Quality of Life in Breast Cancer Patients after Breast Reconstructive Surgery
Rika Ohkuma, MD, Marcelo Lacayo-Baez, MD, Michele A. Manahan, MD, Ariel N. ad, MD, PhD, Justin M. Sacks, MD, Damon S. Cooney, MD, PhD, Carisa M. Cooney, MPH and Gedge D. Rosson, MD
Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
Purpose: Breast reconstruction following mastectomy has been shown to improve quality of life (QoL) scores in studied patients. The goal of this study was to quantify and compare QoL scores for breast cancer patients undergoing different surgical procedures.
Methods: We performed an IRB-approved prospective study of patients undergoing breast reconstruction at the Johns Hopkins Hospital. Two validated questionnaires, the RAND-36 and BREAST-Q©, were administered at four time-points: preoperatively, prior to any additional major reconstruction surgeries (in staged cases), and postoperatively at 6 and 12 months post-reconstruction. Comparisons between pre- and post-operative questionnaire responses were made between patients who underwent autologous vs. implant reconstruction and immediate vs. staged reconstruction. Responses were analyzed using the paired t-test.
Results: Between November 2010 and June 2012, 98 female patients [mean age: 50.42 +/- 9.78 (range 21-74)] were enrolled and completed their major reconstructive surgery. Of these, 32 patients completed their 6-month follow-up: 26 autologous flap reconstructions (18 immediate, 8 staged) and 6 implant reconstructions (all staged). In the comparison with preoperative QoL scores of overall patients who completed the survey, lower scores were found for patients who had tissue expanders (TE) placed for satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being on the chest, and for satisfaction with physical well-being on abdomen 6 months after the main reconstruction. However, postoperative scores showed significantly higher scores in satisfaction with breasts and psychosocial well-being. Among 15 patients who completed 12 months follow-up after reconstruction, significant postoperative improvement was shown in satisfaction with breasts and psychosocial well-being in the autologous flap reconstruction (N=13) and the non-staged reconstruction (N=10) groups. RAND-36 result demonstrated significant improvement in physical functioning and role limitations due to physical health by TE placement; however, it caused pain with lower scores in general health. At post-operative 12 months, the implant (N=2) and the staged reconstruction (N=5) groups showed significantly scores in higher physical functioning and role limitations due to physical health, however, general health scores were higher in the autologous and the immediate reconstruction group.
Conclusion: Patients' post-operative QoL is significantly improved following reconstruction with a positive psychological impact on patients' physical well-being. Autologous tissue flap reconstruction performed in a non-staged manner provide better post-operative satisfaction despite lower physical functioning or role limitations. The role of QoL is an important concent when counseling and planning breast reconstruction for patients choosing between immediate and staged or implant versus autologous types.
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