Patient-reported satisfaction with cosmetic outcome and decision regret after breast conservation and mastectomy in older Chinese breast cancer patient

Abstract

Introduction: Few studies have investigated the optimal surgical management in older breast cancer patients with many elderly patients opting for a mastectomy for simplicity's sake. The aim of this study was to compare the patient-reported satisfaction in cosmetic outcomes and decision regret between breast conserving surgery and mastectomy in older Chinese patients. Methodology: Female Chinese patients equal or older than 70 years of age at the time of breast cancer diagnosis were recruited prospectively between September 2019 to December 2020. A questionnaire was administered to patients who were eligible for a breast conserving surgery (BCS) and mastectomy. Satisfaction with outcomes were measured pre-operatively and post-operatively at six months with the Chinese version of the BREAST-Qsurvey. Decision regret was characterized by the Decision Regret Scale at six months after the operation. Results: Forty-nine patients were recruited and forty-four patients completed the questionnaires (participation rate 90%). Thirty-four patients had mastectomy {77.3%) and ten patients had BCS (22.7%). Patients who received a mastectomy were found to be less satisfied with the cosmetic outcome of their breasts at six months after the operation (BREAST-Q mean scores pre-op 70.7 vs. post-op 58.3, p=0.011). Satisfaction of breast cosmesis remained similar in the group of patients who received a BCS (p=0.13). Neither group demonstrated regret in their decision making of operation option (p=0.612). Conclusion: Elderly patients can show significant dissatisfaction with the cosmetic outcome after a mastectomy. It is crucial to engage the patients in discussion of surgical options to make an informed decision.