One of my life goals, and specifically, as it pertains to this site, is to spread the news about free and open, well composed, peer-reviewed scientific publications. Following that tradition, today’s blog focuses on another key area of women’s health – breast cancer, mastectomy and post-mastectomy reconstruction.
ASCO and MedPage Today are reporting this paper in the Journal of Clinical Oncology, available on MedPage Today for free (link below), that highlights one year, post operative patient survey results, that highlight differences in satisfaction with breasts, among women who opted for two forms of breast reconstructive surgery.
The two forms are Autologous Recovery or Flap Recovery and Implant Reconstruction.
Autologous Recovery, as some of you might guess, involves tissue from the patient’s own body, reconstructed and used as breast tissue. There are two types of tissue recovery possible: free flap, where the tissue is severed from its blood vessel connections and moved or, a pedicled flap, where the blood vessels are still attached as the tissue is moved. Tissue usually arises from areas such as the belly or the back. A link with details is supplied below.
Implant reconstruction doesn’t last a life time, the key difference between this and autologous recovery, and may need multiple surgeries. Usually composed of silicone and saline, these implants are sized and implanted into the body. This method is less invasive, and easier with delayed reconstructive options, and provides the patients with multiple breast shape options, allowing for the most suitable form to be chosen and used. Formerly, this was the best option for women with smaller breasts, because they also usually had less tissue available for reconstruction, but autologous recovery has made strides in this area, so this is no longer seen as a big advantage. Refer to the link below for more information.
The present study
The present study enrolled a large number of patients, 1632, in total, across 11 sites; that were undergoing immediate postmastectomy reconstruction for either invasive cancer and/or carcinoma in situ. There is some argument over whether carcinoma in situ is actually cancer. Regardless of the status of this debate, this is the title for a group of cells/tissue that is precancerous and has not metastasized but is expected to. This is common in breast and a few other cancers, and patients many times choose to undergo mastectomy to fend off cancer.
Patient Reported Outcomes (PRO)
The study was conducted by evaluating Patient Reported Outcomes, also known as PRO. This is a method where validated questionnaires are used, to assess treatments and/or symptoms, from the patients’ perspectives, going beyond clinical measurements, which, for the longest time where the mainstay of medical comparative evaluation. There are barriers to the prevalence of PROs, as internet access, data availability, etc. remain challenges, however it is becoming an accepted research form, especially where patients themselves would be the best judges of outcomes.
Care must be taken when interpreting patient reported outcomes, valuable as they are, and especially so, when using them for labeling claims. The FDA has also weighed in.
In this study, using a generic PRO measure, Patient-Reported Outcomes Measurement Information System–29, patients were quizzed before, and one year after surgery. If you want to read and learn more about PROMIS, I have appended a link below.
The Results and Conclusions
Using the scoring system, and based on the response of 1183 patients, the researchers concluded that patients with Autologous Recovery/Reconstruction had better satisfaction with their breasts and mental well being. Anxiety and depression were reduced in both groups, however, neither group had fully recovery of chest health. There was increased pain with Autologous Recovery, while patients with Implant Reconstruction had reduced fatigue. overall, it appears patients who underwent Autologous Reconstruction had a slight edge. I have attached links to the summary and the article below.
- The ASCO study summary: https://www.medpagetoday.com/reading-room/asco/breast-cancer/64962?xid=NL_ASCORR_2017-05-11&eun=g5100781d39r&pos=1111 Note: The full paper link is available on the same page.
- Autologous Recovery: http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous
- Implant Reconstruction: http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants
- PROMIS: http://www.nihpromis.com/?AspxAutoDetectCookieSupport=1#1
- A Paper on Patient-Reported Outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227331/
- Carcinoma in situ: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46488
- FDA Guidance on the use of Patient-Reported Outcome Measures: https://www.fda.gov/downloads/drugs/guidances/ucm193282.pdf
- Image Courtesy, Pexels: https://www.pexels.com/photo/flower-pink-peony-blouse-112324/