Contralateral prophylactic mastectomy and breast cancer clinical and psychosocial outcomes
Women completed validated questionnaires assessing psychosocial factors including quality of life (QOL), body image concerns, cancer worry, cancer distress, and decisional satisfaction at time points presurgery and at 1, 6, and 12 months postsurgery. We fitted repeated measures models to assess the...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
2018, [2018]
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Women completed validated questionnaires assessing psychosocial factors including quality of life (QOL), body image concerns, cancer worry, cancer distress, and decisional satisfaction at time points presurgery and at 1, 6, and 12 months postsurgery. We fitted repeated measures models to assess the association between psychosocial scores and CPM status, adjusting for time effect. For study aim 2, we developed a decision model to simulate the survival outcomes of women who undergo CPM and women who do not, considering age, stage, estrogen receptor (ER) status, and degree of family history of breast cancer. The results were used to develop an online risk-prediction tool. RESULTS OF STUDY AIM 1: Among 252 women who completed presurgery and postsurgery questionnaires, mean age was 56 years (range, 25-82 years), 60% were non-Hispanic White, 16% were non-Hispanic Black, 16% were Hispanic, and 8% were of mixed race. Seventeen percent had CPM. Women who had CPM tended to be younger (P < .01) and Hispanic (P < .01). After adjusting for time effect (presurgery vs postsurgery), women who had CPM had higher scores for cancer distress (P = .03), body image concerns (P < .01), and QOL (P < .01) than did women who did not undergo CPM. There was no statistically significant difference by CPM status for decisional satisfaction. RESULTS OF STUDY AIM 2: The decision model demonstrated that the greatest increase in quality-adjusted life expectancy with CPM was women aged 40 with an ER-negative, stage I breast cancer and a first-degree relative with breast cancer. CPM had no or a reduced effect on quality-adjusted life expectancy among women aged 50 or older regardless of stage or family history of breast cancer. The maximum 20-year absolute overall survival increase with CPM was 1.21%. CONCLUSIONS: The results of study aim 1 suggest that psychosocial factors such as cancer distress, QOL, and body image concerns do not improve after having CPM. The results highlight the importance of evaluating women for these psychosocial factors presurgery and postsurgery in order to identify those for whom psychosocial assessment and counseling should be recommended. We will evaluate in a future study whether the risk prediction tool enhances a woman's understanding of the small survival benefit of CPM and whether that influences her decision about having CPM. BACKGROUND: The majority of women diagnosed with breast cancer are at low risk of developing contralateral breast cancer; however, increasing numbers of women are choosing to have the cancer-free breast removed (contralateral prophylactic mastectomy [CPM]) in addition to the affected breast. The objective of the study was to examine the survival and psychosocial outcomes of women with unilateral breast cancer having CPM vs those not having CPM. The specific aims were to (1) prospectively examine the psychosocial outcomes of women with sporadic breast cancer having CPM vs those not having CPM, and (2) conduct a decision model to provide estimates of the effect of CPM on survival outcomes. METHODS: For study aim 1, we enrolled 308 women with newly diagnosed breast cancer before breast surgery at the MD Anderson Cancer Center and the Kelsey-Seybold community clinic between 2012 and 2015. |
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| Physical Description: | 1 PDF file (59 pages) illustrations |