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Past
Patient-reported outcomes are increasingly used to capture other aspects of the cancer care experience not captured by traditional measures of survival, recurrence, and complications.1 The BREAST-Q is a patient-reported outcome measure (PROM) specifically developed to measure post-surgical outcomes, including satisfaction with breasts and care, that contribute to quality of life.2 This tool has been validated in a variety of settings.3
Present
The BREAST-Q is in widespread use to assess satisfaction and surgery-related quality of life as reported by patients. It has been used to assess outcomes after breast-conserving surgery and mastectomy with and without reconstruction. Although these studies report meaningful outcomes for patients who engage in PROMs, the population of patients who do not engage in PROMs, including the BREAST-Q, has not been well characterized. This study of 6374 consecutive patients who were sent two PROMs, the BREAST-Q and a postoperative Recovery Tracker, demonstrated that 88.7% of patients responded to one of the PROMs.4 Non-responders were more often older (age > 70 years), of Black race, and non-English-speaking. These results suggest that patient engagement using PROMs after breast surgery is high but raise concerns that PROM results may not reflect the experience of the entire breast cancer population.
Future
Although engagement with PROMs was high in this study, the aging of the population and its increasing diversity indicate the need for more innovative methods for delivery of PROMs to ensure representation of the entire population of breast cancer patients. This could include screening to identify patients who are not engaging with these tools, enhanced accessibility with both paper and electronic surveys, assistance to complete surveys, including education of family members as part of preoperative teaching to broaden assistance, and translation of PROMs with integration of multiple versions into the electronic medical record.
References
Cano S, Klassen AF, Scott A, Thoma A, Feeny D, Pusic A. Health outcome and economic measurement in breast cancer surgery: challenges and opportunities. Expert Rev Pharmacoecon Outcomes Res. 2010;10:583–94.
Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124:345–53.
Cano SJ, Klassen AF, Scott AM, Cordeiro PG, Pusic AL. The BREAST-Q: further validation in independent clinical samples. Plast Reconstr Surg. 2012;129:293–302.
Srour MK, Tadros AB, Sevilimedu V, et al. Who are we missing: does engagement in patient-reported outcome measures for breast cancer vary by age, race, and disease stage? Ann Surg Oncol. 2022. https://doi.org/10.1245/s10434-022-12477-1.
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Srour, M.K., Tadros, A.B. & Morrow, M. ASO Author Reflections: Engagement in Patient-Reported Outcomes for Breast Cancer. Ann Surg Oncol 29, 7974 (2022). https://doi.org/10.1245/s10434-022-12481-5
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DOI: https://doi.org/10.1245/s10434-022-12481-5