Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

Abstract

Purpose To evaluate patient-reported cosmetic satisfaction in women treated with radiation therapy for breast cancer and to determine the association between dissatisfaction and quality of life (QoL) and depression. Methods Within the prospective UMBRELLA breast cancer cohort, all patients ≥ 1 year after breast conserving treatment or mastectomy with immediate reconstruction were selected. Self-reported cosmetic satisfaction was measured on a 5-point Likert scale. QoL, social functioning, and emotional functioning were measured using EORTC QLQ-C30 and BR23 at 1, 2, and 3 years after inclusion. Mixed model analysis was performed to assess the difference in different domains of QoL between patients with good versus poor self-reported cosmetic satisfaction over time after adjustment for potential confounders. Depression scores were collected by means of the HADS-NL questionnaire. Chi-square test or Fisher's exact test was used to assess the difference in proportions of HADS score ≥ 8, indicating increased depression risk, between satisfied and dissatisfied patients. Results 808 patients were selected for analysis. Respectively one, two, and three years after surgery, 8% (63/808), 7% (45/626), and 8% (31/409) of patients were dissatisfied with their cosmetic outcome. Poor patient-reported cosmetic satisfaction was independently associated with impaired QoL, body image, and lower emotional and social functioning. Scores ≥ 8 on the HADS depression subscale were significantly more common in dissatisfied patients. Conclusions Dissatisfaction with cosmetic outcome was low after breast cancer surgery followed by radiation therapy during 3 years follow-up. Knowing the association between dissatisfaction with cosmetic outcome and QoL and depression could help to improve the preoperative counseling of breast cancer patients.

Prospective Comparison of Hypofractionated Versus Normofractionated Intensity-Modulated Radiotherapy in Breast Cancer: Late Toxicity Results of the Non-Inferiority KOSIMA Trial (ARO2010-3)

“…The main advantages of BCT are better cosmetic, lower toxicity results, and reduced psychological and emotional load when compared to radical surgical approaches. This premise has been confirmed by the reported satisfaction levels amongst patients treated with conservative surgery plus radiotherapy, in favor of this method ( 10 ). However, classical long radiotherapy times, taking about 5-7 weeks, could also be considered as inconvenient for many patients.…”

Clinical observation of the regeneration process of defects after breast cancer resection

“…Oxidized regenerated cellulose and gelatin sponge are the commonly used artificial hemostatic fillers in clinic. Using these to fill the residual cavity after breast-conserving surgery does not increase the operation time and the incidence of complications [ 5 , 6 , 22 , 23 ]. Therefore, it was speculated that these two materials may play a role in the repair and shaping of the breast, while achieving the goal of hemostasis.…”

“…Second, postoperative changes should be clearly distinguished from the real recurrent lesion area of breast cancer. Third, the material should be capable of withstanding radiotherapy or chemotherapy, without serious complications [ 23 – 27 ]. The absorption time of oxidized regenerated cellulose is slightly longer than that of gelatin sponge.…”

“…Postoperative adjuvant chemotherapy, and endocrine and targeted therapy were performed according to the patient’s condition, and all patients were treated with adjuvant radiotherapy. The Harvard/NSABP/RTOG Breast Cosmetic Grading Scale was used to evaluate the cosmetic effect of patients who had surgery for more than six months, including the surgeon’s evaluation and the patient’s self-evaluation [ 23 ].…”

Targeted Next-Generation Sequencing for the Identification of Genetic Predictors of Radiation-Induced Late Skin Toxicity in Breast Cancer Patients: A Preliminary Study

“…Ionizing radiation generates reactive oxygen species that lead to localized inflammation, which ultimately evolves into a fibrotic process characterized by increased collagen deposition, poor vascularity, and scarring [5]. This leads to breast indurations and in some cases to a poor cosmetic outcome that may have an impact on patients' quality of life [6]. Factors affecting the risk of developing late radiation-induced skin injuries include RT parameters, such as total dose given, irradiated volume, dose fractionation, and treatment duration, as well as some patient characteristics, such as their age and lifestyle [7,8].…”