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.