Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

Xia, Wei; Oxley, Samuel; Sideris, Michail; Kalra, Ashwin; Brentnall, Adam R.; Li, Sun; Yang, Li; Legood, Rosa; Manchanda, Ranjit

doi:10.1016/j.ajog.2023.03.045

Cited by 6 publications

(7 citation statements)

References 85 publications

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“…Lower HT adherence has been reported after RRSO in some populations and contexts, which reduces RRSO cost-effectiveness. HT management and compliance is important for symptom control and ameliorating detrimental long-term health consequences, including CHD . Women should be appropriately counselled on the benefits and risks of HT before RRSO.…”

Section: Discussionmentioning

confidence: 99%

“…The uptake and timing of preventive surgery can be varied for eligible PV carriers and increases with time . Sexual dysfunction and menopause symptoms after RRSO and body image and sexual pleasure issues after RRM have been reported, despite reduced cancer distress and unaffected generic quality of life . Possible surgical complications (RRSO, 3%-5%; RRM, 20% with reconstruction) should be factored into counseling to facilitate informed decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…HT management and compliance is important for symptom control and ameliorating detrimental long-term health consequences, including CHD. 66 , 67 Women should be appropriately counselled on the benefits and risks of HT before RRSO. HT adherence appears higher in specialist centers or high-risk familial clinics.…”

Section: Discussionmentioning

confidence: 99%

“… 22 , 79 Sexual dysfunction and menopause symptoms after RRSO and body image and sexual pleasure issues after RRM have been reported, despite reduced cancer distress and unaffected generic quality of life. 67 Possible surgical complications (RRSO, 3%-5% 80 ; RRM, 20% with reconstruction 81 , 82 ) should be factored into counseling to facilitate informed decision-making. Our scenario analyses including age and type of surgery, HT use following premenopausal RRSO, and estimates of cancers prevented further supported and informed counselling of women and decision-making for surgery for each individual carrier.…”

Section: Discussionmentioning

confidence: 99%

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Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Wei,

Sun,

Slade

et al. 2024

JAMA Netw Open

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ImportancePathogenic variants (PVs) in BRCA1, BRCA2, PALB2, RAD51C, RAD51D, and BRIP1 cancer susceptibility genes (CSGs) confer an increased ovarian cancer (OC) risk, with BRCA1, BRCA2, PALB2, RAD51C, and RAD51D PVs also conferring an elevated breast cancer (BC) risk. Risk-reducing surgery, medical prevention, and BC surveillance offer the opportunity to prevent cancers and deaths, but their cost-effectiveness for individual CSGs remains poorly addressed.ObjectiveTo estimate the cost-effectiveness of prevention strategies for OC and BC among individuals carrying PVs in the previously listed CSGs.Design, Setting, and ParticipantsIn this economic evaluation, a decision-analytic Markov model evaluated the cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) and, where relevant, risk-reducing mastectomy (RRM) compared with nonsurgical interventions (including BC surveillance and medical prevention for increased BC risk) from December 1, 2022, to August 31, 2023. The analysis took a UK payer perspective with a lifetime horizon. The simulated cohort consisted of women aged 30 years who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. Appropriate sensitivity and scenario analyses were performed.ExposuresCSG-specific interventions, including RRSO at age 35 to 50 years with or without BC surveillance and medical prevention (ie, tamoxifen or anastrozole) from age 30 or 40 years, RRM at age 30 to 40 years, both RRSO and RRM, BC surveillance and medical prevention, or no intervention.Main Outcomes and MeasuresThe incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained. OC and BC cases and deaths were estimated.ResultsIn the simulated cohort of women aged 30 years with no cancer, undergoing both RRSO and RRM was most cost-effective for individuals carrying BRCA1 (RRM at age 30 years; RRSO at age 35 years), BRCA2 (RRM at age 35 years; RRSO at age 40 years), and PALB2 (RRM at age 40 years; RRSO at age 45 years) PVs. The corresponding ICERs were −£1942/QALY (−$2680/QALY), −£89/QALY (−$123/QALY), and £2381/QALY ($3286/QALY), respectively. RRSO at age 45 years was cost-effective for RAD51C, RAD51D, and BRIP1 PV carriers compared with nonsurgical strategies. The corresponding ICERs were £962/QALY ($1328/QALY), £771/QALY ($1064/QALY), and £2355/QALY ($3250/QALY), respectively. The most cost-effective preventive strategy per 1000 PV carriers could prevent 923 OC and BC cases and 302 deaths among those carrying BRCA1; 686 OC and BC cases and 170 deaths for BRCA2; 464 OC and BC cases and 130 deaths for PALB2; 102 OC cases and 64 deaths for RAD51C; 118 OC cases and 76 deaths for RAD51D; and 55 OC cases and 37 deaths for BRIP1. Probabilistic sensitivity analysis indicated both RRSO and RRM were most cost-effective in 96.5%, 89.2%, and 84.8% of simulations for BRCA1, BRCA2, and PALB2 PVs, respectively, while RRSO was cost-effective in approximately 100% of simulations for RAD51C, RAD51D, and BRIP1 PVs.Conclusions and RelevanceIn this cost-effectiveness study, RRSO with or without RRM at varying optimal ages was cost-effective compared with nonsurgical strategies for individuals who carried BRCA1, BRCA2, PALB2, RAD51C, RAD51D, or BRIP1 PVs. These findings support personalizing risk-reducing surgery and guideline recommendations for individual CSG-specific OC and BC risk management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Wei,

Sun,

Slade

et al. 2024

JAMA Netw Open

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“…When prospective data in patients are not available, mapping from other questionnaires should be considered [24]. Our recent systematic review and meta-analysis reports the QoL outcomes following RRM and RRSO in patients at increased risk of BC/OC [25]. This review found no study that has reported post-operative outcomes using the EQ-5D or any alternative questionnaire for deriving HRUSs such as the SF-6D.…”

Section: Introductionmentioning

confidence: 99%

Utility Scores for Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy: Mapping to EQ-5D

Oxley,

Wei,

Sideris

et al. 2024

Cancers

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Background: Risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) are the most effective breast and ovarian cancer preventive interventions. EQ-5D is the recommended tool to assess the quality of life and determine health-related utility scores (HRUSs), yet there are no published EQ-5D HRUSs after these procedures. These are essential for clinicians counselling patients and for health-economic evaluations. Methods: We used aggregate data from our published systematic review and converted SF-36/SF-12 summary scores to EQ-5D HRUSs using a published mapping algorithm. Study control arm or age-matched country-specific reference values provided comparison. Random-effects meta-analysis provided adjusted disutilities and utility scores. Subgroup analyses included long-term vs. short-term follow-up. Results: Four studies (209 patients) reported RRM outcomes using SF-36, and five studies (742 patients) reported RRSO outcomes using SF-12/SF-36. RRM is associated with a long-term (>2 years) disutility of −0.08 (95% CI −0.11, −0.04) (I2 31.4%) and a utility of 0.92 (95% CI 0.88, 0.95) (I2 31.4%). RRSO is associated with a long-term (>1 year) disutility of −0.03 (95% CI −0.05, 0.00) (I2 17.2%) and a utility of 0.97 (95% CI 0.94, 0.99) (I2 34.0%). Conclusions: We present the first HRUSs sourced from patients following RRM and RRSO. There is a need for high-quality prospective studies to characterise quality of life at different timepoints.

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Patient-reported quality of life might depend on prophylactic or therapeutic surgery for women with higher genetic predisposition to breast or ovarian cancer

Zhou,

Wu,

Zhang

2024

American Journal of Obstetrics and Gynecology

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Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis

Cited by 6 publications

References 85 publications

Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Cost-Effectiveness of Gene-Specific Prevention Strategies for Ovarian and Breast Cancer

Utility Scores for Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy: Mapping to EQ-5D

Patient-reported quality of life might depend on prophylactic or therapeutic surgery for women with higher genetic predisposition to breast or ovarian cancer

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