Long-Term Quality of Life in Patients with Breast Cancer after Breast Conservation vs Mastectomy and Reconstruction

Importance: Treatment options for early breast cancer include breast-conserving surgery with radiation therapy (RT) or mastectomy and breast reconstruction without RT. Despite marked differences in these treatment strategies, little is known with regard to their association with long-Term quality of life (QOL). Objective: To evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-Term QOL. Design, Setting, and Participants: This comparative effectiveness research study used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. The study sample was mailed a survey between March 2017 and April 2018. Data were analyzed from August 1, 2018 to October 15, 2021. Exposures: Breast-conserving surgery with RT or mastectomy and reconstruction without RT. Main Outcomes and Measures: The primary outcome was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. Secondary outcomes included BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. Multivariable linear regression models with weights for treatment, age, and race and ethnicity tested associations of the exposure with outcomes. Results: Of 647 patients who responded to the survey (40.0%; 356 had undergone breast-conserving surgery, and 291 had undergone mastectomy and reconstruction), 551 (85.2%) confirmed treatment with breast-conserving surgery with RT (n = 315) or mastectomy and reconstruction without RT (n = 236). Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years). Multivariable analysis showed no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71; 95% CI,-2.45 to 7.88; P =.30) or physical well-being (effect size,-1.80; 95% CI,-5.65 to 2.05; P =.36). In contrast, psychosocial well-being (effect size,-8.61; 95% CI,-13.26 to-3.95; P <.001) and sexual well-being (effect size,-10.68; 95% CI,-16.60 to-4.76; P <.001) were significantly worse with mastectomy and reconstruction without RT. Health utility (effect size,-0.003; 95% CI,-0.03 to 0.03; P =.83) and decisional regret (effect size, 1.32; 95% CI,-3.77 to 6.40; P =.61) did not differ by treatment group. Conclusions and Relevance: The findings support equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.