Evaluating the cosmetic outcome of breast reconstruction: a comparison of patients' and healthcare professionals' views and their associations with patient satisfaction and quality of life.
Authors: S Potter, HJ Thomson, RJ Greenwood, SJ Cawthorn, M Beresford, MI Calder, Z Rayter, ZE Winters
Journal: Cancer Research (2009)

Abstract Abstract #4135 Introduction: Objective cosmetic assessment, performed by surgeons, has traditionally been used to evaluate the success of breast reconstruction (BR). It is unclear however, how this assessment relates to the patient's perception of the cosmetic outcome their reconstruction or to other key patient-reported outcomes such as satisfaction or health-related quality of life (HRQL). Here for the first time, we compare patients and healthcare professionals (HCPs) assessments of the cosmetic outcome of their breast reconstruction and evaluate whose opinion, if any, is associated with health-related quality of life (HRQL) and patient satisfaction.&amp;#x2028; Methods: Women who had undergone immediate latissimus dorsi breast reconstruction between 6 and 60 months previously completed a study-specific cosmetic outcome questionnaire and 4 HRQL-instruments (EORTC-QLQ-C30+BR23, FACT-B, Body Image Scale (BIS) and HADS). Standardised 4-view photographic assessment was also performed for each woman and evaluated by a panel consisting of a breast surgeon, clinical oncologist, breast research nurse and female layperson. Weighted kappa statistics were used to investigate the agreement between patients' and panel members' evaluations of cosmetic outcome and overall patient satisfaction and Spearman's rank correlation was used to evaluate the association between these scores and HRQL domains. Full ethical approval was obtained for the study.&amp;#x2028; Results: 75 women completed questionnaires and attended for photographic assessment. Poor agreement was seen between patient and panel cosmesis scores, ranging from kappa = 0.19 (lay person/patient) to kappa = 0.27 (oncologist/patient). Significant agreement was seen between the patient's assessment of cosmetic outcome and their overall satisfaction with their reconstruction (kappa 0.52), but there was no agreement between patients' overall satisfaction and the panel's assessment of cosmesis (kappa 0.02-0.27). Good cosmetic outcome, regardless of rater, however was associated with better body image scores and improved HRQL as assessed by total FACT-B-scores.&amp;#x2028; Conclusions: Following breast reconstruction, cosmetic outcome appears to be associated with HRQL. Patients and HCPs, however, view cosmetic outcome very differently and ultimately only patients' cosmetic evaluation scores showed a good agreement with overall satisfaction, arguably the most important outcome of reconstructive surgery of this kind. The study suggests that traditional surgeon-led cosmetic assessments are of limited value in evaluating the true outcome of reconstruction and highlights that patient-reported outcomes should form an integral part of the comprehensive assessment of the success (or failure) of reconstructive surgery. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4135.