Abstract P5-15-05: Long-term quality of life after four common surgical treatment pathways for breast cancer and the effect of complications
Authors: Kouwenberg CA , Ligt KM , Rakhorst HA , Leeuw D , Siesling S , Buschbach JJ , Kranenburg LW , Mureau MA 
Published: May 2019

Abstract
Background: Comparing the quality of life (QoL) for all common breast cancer surgery options could support decision-making. However, current evidence generally consists of non-preference-based outcomes for sub-comparisons of options which are unsuitable for the calculation of Quality Adjusted Life Years (QALYs), the preferred outcome in health economics. The preference-based EQ-5D-5L is specifically designed to provide the Q in QALY and could facilitate a (health-care) wide comparison of breast cancer surgery options. This study gives an overview of both non-preference and preference-based QoL after four common surgical breast cancer treatment pathways.
Method: Breast cancer patients from a large multicenter observational cohort in the Netherlands were invited for participation in an online survey. QoL was obtained by the EQ-5D-5L, EORTC-QLQ-C30/-BR23 and Breast-Q questionnaires. Patient cohorts based on surgical procedure (breast-conserving surgery (BCS), mastectomy (MAS), autologous breast reconstruction (A-BR) and implant-based breast reconstruction (I-BR) were compared after propensity-weighted adjustment of pretreatment differences.
Results: Of all invited patients, 1871 responded, respectively patients treated with BCS (n=615), MAS (n=507), A-BR (n=330), and I-BR (n=419). Table 1 shows QoL outcomes without overlapping 95% CI. Patients reported complications in 47% of the A-BR, 32% of the I-BR, 18% BCS and 22% of the MAS groups. QoL outcomes differed statistically significantly between patients with and without complications for all groups, except the I-BR group.
Table 1:patient-reported quality of life per surgical treatment for propensity-weighted cohorts BCSMASA-BRI-BR Estimated sample sizen=434.0n=386.3n=178.6n=295.5EQ-5D-5L Utility Overall0.844a0.805b0.849a0.850a No complication0.859a0.878b0.847a0.818a,b Complication0.771a0.771a,c0.816b,c0.861bBreast-Q Satisfaction with breasts 65.52a60.65b71.29c59.39b Satisfaction with outcome 75.75a66.37b Psychosocial well-being 73.77a66.50b75.78a71.60a Sexual well-being 62.70a50.00b63.33a56.38c Physical well-being: chest 67.39a73.47b,c75.81c72.64bEORTC-QLQ-C30 Physical function 84.53a82.94a85.62a,b87.97b Role function 84.35a80.70b84.02a,b86.02a Pain 15.41a18.93b17.18a,b15.89a,b Financial problems 5.23a8.22b12.30b7.71a,bEORTC-QLQ-BR23 Body image 87.45a80.49b82.28b82.35b Sexual functioning 27.90a27.51a31.95a,b33.35b Sexual enjoyment 57.03a54.82a64.24b63.80b Breast symptoms 13.45a9.94b8.79b10.82a Arm symptoms 12.68a17.12b18.18b16.82dMean values of the respective outcome scale after propensity score weighting and are derived from an estimator of the average treatment effect on the population. Values in the same row not sharing the same subscript do not show overlapping 95% Confidence Intervals in a pairwise comparison.
Discussion: Preference-based QoL outcomes are an essential input for cost-effectiveness analyses, used to justify the use of care in a society progressively confronted with increasing health care expenses. The results from this large multicenter cohort study contribute substantially to the current knowledge in the field of breast cancer reconstructive surgery.
Citation Format: Kouwenberg CA, Ligt KM, Rakhorst HA, Leeuw D, Siesling S, Buschbach JJ, Kranenburg LW, Mureau MA. Long-term quality of life after four common surgical treatment pathways for breast cancer and the effect of complications [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-05.