Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study
Davis LE, Fulton C, Bubis LD, Sussman J, Moody L, Barbera L, Li Q, Mahar AL, Coburn NG, Holloway CMB. Breast Cancer Res Treat. 2019; 175(3):721-31. Epub 2019 Mar 16. DOI: 10.1007/s10549-019-05196-x.
Purpose — Studies examining symptom differences between surgeries for breast cancer patients rarely incorporate the effects of adjuvant treatment choice. We sought to understand differences in patient-reported symptoms between lumpectomy plus radiation and mastectomy in the year following surgery.
Methods — This cohort study used linked administrative datasets. The exposure was defined as lumpectomy plus radiation or mastectomy. The outcomes of moderate-to-severe (score ≥ 4) patient-reported symptoms were obtained using the Edmonton symptom assessment system (ESAS). Line plots were created to determine symptom trajectories in the 12 months following surgery, and the relationships between surgery and each of the nine symptoms were assessed using multivariable analyses. Clinical significance was determined as a difference of 10%.
Results — Of 13,865 Stage I–II breast cancer patients diagnosed 2007–2015, 11,497 underwent lumpectomy plus radiation and 2368 underwent mastectomy. Symptom trajectories were similar for all nine symptoms until approximately 5 months postoperatively when they diverged and mastectomy symptoms started becoming more severe. On multivariable analyses, patients undergoing mastectomy were at an increased risk of reporting moderate-to-severe depression (RR 1.19, 95% CI 1.09–1.30), lack of appetite (RR 1.11, 95% CI 1.03–1.20), and shortness of breath (RR 1.16, 95% CI 1.04–1.15) compared to those undergoing lumpectomy plus radiation.
Conclusions — Even with the addition of adjuvant radiation, patients who are treated with lumpectomy fare better in three of nine patient-reported symptoms. Further examination of these differences will assist in better shared decision-making regarding surgical treatments.