Association of Radiation Timing with Long-Term Satisfaction and Health-Related Quality of Life in Prosthetic Breast Reconstruction

Abstract

Background: Radiation therapy is increasingly used after breast cancer surgery, which may impact patients’ postoperative quality of life. This study assessed differences in long-term patient satisfaction and health-related quality of life after radiation therapy administered at different stages of implant-based breast reconstruction or with no radiation after surgery. Methods: In this observational study, long-term outcomes were evaluated for four cohorts of women who completed breast reconstruction and received (1) no radiation, (2) radiation before tissue expander placement, (3) radiation after tissue expander placement, or (4) radiation after permanent implant between 2010 and 2017 at Memorial Sloan Kettering. Satisfaction and health-related quality of life were assessed using the prospectively collected Satisfaction with Breasts and Physical Well-Being of Chest BREAST-Q subscales. Score distributions were examined by radiation exposure status for 3 years after surgery using nonparametric analyses and regression models. Results: Of 2932 patients who met the inclusion criteria, 25.8 percent received radiation during breast cancer treatment, including before tissue expander placement (n = 239; 8.2 percent), after tissue expander placement (n = 290; 9.9 percent), and after implant placement (n = 228; 7.8 percent). Radiotherapy patients had average scores 7 to 9 points lower at all postoperative time points for Satisfaction with Breasts and Physical Well-Being of Chest subscales (p < 0.001). Although patient-reported outcomes did not differ by radiation timing, there were higher rates of severe capsular contracture with postimplant radiotherapy (p < 0.001). Conclusions: Radiation therapy significantly affected patient satisfaction and health-related quality of life following implant breast reconstruction through 3 years postoperatively. Patient perception of outcome was unaffected by radiotherapy timing; however, capsular contracture was higher after postimplant radiotherapy, suggesting there may be an advantage to performing radiotherapy before placement of the final reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

“…Radiation has been associated with increased chronic postsurgical pain and chest/upper body discomfort in patients undergoing breast reconstruction by causing skin retraction and tightness. [39][40][41] Lastly, physical therapy is often advised for patients undergoing breast reconstruction to alleviate postsurgical pain. 42 However, patients with public insurances may be less inclined to attend physical therapy and other rehabilitative programs, and may not realize the health benefits associated with physical therapy.…”

Methods in regression analysis in surgical oncology research‐best practice guidelines

“…Patient and surgical variables included age, race, ethnicity, marital status, insurance status, BMI, smoking status, diabetes, cardiovascular disease, laterality, chemotherapy, radiation therapy, mastectomy technique, and pocket dissection. Prior work has shown that each covariate is related to or has been hypothesized to have a relationship with the outcome of interest 12–16 . All regression models (logistic and linear) included the same set of predictor variables.…”

“…Prior work has shown that each covariate is related to or has been hypothesized to have a relationship with the outcome of interest. [12][13][14][15][16] All regression models (logistic and linear) included the same set of predictor variables. p values < 0.05 were considered to indicate statistical significance.…”

Effects of Elective Revision After Breast Reconstruction On Patient-Reported Outcomes

“…Prior studies from the Mastectomy Reconstruction Outcomes Consortium have similarly found that radiation prior to flap or implant placement is well tolerated and does not substantially worsen patient satisfaction. 11,[24][25][26] This article is protected by copyright. All rights reserved.…”