Abstract P4-11-01: Factors influencing patient reported cosmetic outcome: Results of the Young Boost trial
Authors: Brouwers P , van Werkhoven E , van Loon J , Leer JW , Poortmans P , Bartelink H , Boersma L 
Published: May 2016

Abstract
Purpose
The Young Boost trial (YBT), a multicenter RCT (NCT00212121), investigates whether a higher boost dose leads to a lower recurrence rate in young patients treated with breast conserving therapy. Cosmetic outcome is the secondary objective. The aim of the current analysis is to investigate which factors influence the patients' opinion about cosmesis.
Patients & methods
From 2004-2011, 2421 breast cancer patients ≤ 50 yrs were included in The Netherlands, France, and Germany. All patients were treated with lumpectomy, followed by 50 Gy whole breast irradiation. Patients were randomized to receive a standard 16 Gy (n=1211) or a high 26 Gy boost (n=1210) to the tumour bed. Cosmesis was scored prior to radiation therapy, at 1 year and at 4 years follow-up according to the following three scoring systems:
1. BCCT.core: Digital photographs were analyzed using a software program to extract an overall cosmetic score: excellent, good, fair or poor. This score is based on symmetry, skin colour and scar visibility. The 7 features of symmetry in the BCCT.core program are:
 pBRA (nipple position)
 pLBC (level of lower breast contour)
 pUNR (level of nipple)
 pBCE (distance from nipple to inframammary fold)
 pBCD (length of breast contour)
 pBAD (area of the breast)
 pBOD (non overlapping area between left and right breast)
2. Physician's score: excellent, good, fair or poor
3. Patients' score using a validated patient's questionnaire about the breast appearance, including an overall score: very satisfied, satisfied, not dissatisfied, dissatisfied or very dissatisfied. Very satisfied and satisfied were grouped as satisfactory.
At the same time points fibrosis was scored by the physician on a 4-point scale. The presence of rib pain was scored as well.
First, we analyzed the correlation between the 3 scoring methods. Secondly, we analyzed the 7 features of BCCT.core in a proportional odds model, to investigate which parameters are related to the patients' opinion about cosmesis at 4 years. Also, we analyzed whether fibrosis score or presence of rib pain are related to the patients' opinion on cosmetic outcome.
Results
At 4 years, the agreement between the different scoring methods was low. The agreement between the physician and the patient was the highest (kappa 0.42), compared to the agreement between the patient and BCCT.core (kappa 0.26) or between BCCT.core and physician (kappa 0.39).
Of the 7 BCCT.core parameters, pBCE and pBCD are significantly related to patients' score at 4 years (table 1). Further, patients with any fibrosis interpret their cosmesis worse than patients without fibrosis, even when the objective score (i.e. BCCT.core) was similar. This effect was larger by increasing grade of fibrosis. The presence of rib pain had no influence.
Conclusion
The patients 'opinion on cosmetic outcome was significantly related to the score on pBCE and pBCD, and to the severity of fibrosis. The correlation between objective score and subjective scores (patient and physician) was low.
oddsppBRA1.3190.150pLBC1.1420.477pUNR1.0560.779pBCE1.1770.040pBCD1.7180.041pBAD0.8560.505pBOD1.0380.812
Citation Format: Brouwers P, van Werkhoven E, van Loon J, Leer JW, Poortmans P, Bartelink H, Boersma L. Factors influencing patient reported cosmetic outcome: Results of the Young Boost trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-01.