Patient-Reported Outcome Measurement Compared with Professional Judgment of Cosmetic Results after Breast-Conserving Therapy

Abstract

Background In the present study, we set out to compare patient reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome.Methods Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years’ follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair–poor Harvard score was estimated using logistic regression analysis.Results The study included 108 female patients (age: 40–91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38–0.50). The items “size” and “shape” were identified as the strongest determinants of cosmetic outcome.Conclusions Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts

“…On the topic of long-term outcomes after reconstructive surgery, the literature contains few quantitative studies that rely on objective data. An important reason for this occurrence may be that postsurgical cosmesis—a large part of overall long-term outcomes—is extremely difficult to quantify objectively, and large discrepancies often exist between patient perception and physician assessment . Our study may be one of the earliest attempts to measure long-term postsurgical outcomes by quantifying it as the proportion of patients who requested or were offered a corrective measure.…”

Chinese multicentre prospective registry of breast cancer patient-reported outcome-reconstruction and oncoplastic cohort (PRO-ROC): a study protocol

“…Studies showed that outcomes were scored differently by patients and professionals, and CRO and photographs might underestimate complications as compared with PROs 33 37. Sparano et al 3 systematically investigated the concordance between clinician-reported symptomatic adverse events (AEs) and information obtained via PROMs in 207 cancer RCTs, and found that 64.2% RCTs showed a discordance in AEs between PRO and CRO.…”

“…Sparano et al 3 systematically investigated the concordance between clinician-reported symptomatic adverse events (AEs) and information obtained via PROMs in 207 cancer RCTs, and found that 64.2% RCTs showed a discordance in AEs between PRO and CRO. Brands-Appeldoorn et al 37 showed agreement between professionals and patients about cosmetic outcomes was fair to moderate (intraclass correlation coefficients (ICC) range: 0.38–0.50). Other studies also confirmed that the overall concordance between clinicians and patients is low 38.…”

Scar and Scarring in the Elderly

“…The poor quality of the scar is usually not a major problem (appearance, color, shape) [12] except in exposed regions (face) or when impacting the function (heel, eyelid, and periorificial areas).…”