Presenter(s)
K. P. Meiyappan1,2, M. Gaonkar3, J. Y. Lin4, M. Bhave5, X. Yang4, T. Liu6, A. H. Miller7, and M. Torres1,8; 1Department of Radiation Oncology, Emory University, Atlanta, GA, 2Winship Cancer Institute, Emory University, Atlanta, GA, 3Emory University, Atlanta, GA, 4Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 5Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, 6Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, 7Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 8Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA
Purpose/Objective(s):
Patient reported outcomes (PROs) of radiation (RT)-induced changes to the breast are important clinical endpoints impacting long-term quality of life. The primary objective was to determine if PROs regarding 1) Cosmetic Difference (CD) – perceived differences in texture, thickening, and symmetry of the irradiated versus (vs.) nonirradiated breast and 2) Cosmetic Satisfaction (CS) – happiness with breast cosmetic outcome – reflect objective measures of RT-induced breast asymmetry [percentage breast retraction assessment (pBRA)] and skin thickening [skin thickening ratio (STRA)]. We also evaluated whether these PROs are influenced by additional factors including mood [Inventory of Depressive Symptomatology Self-Report (IDS-SR)] and sleep [Pittsburgh Sleep Quality Index (PSQI)].Materials/Methods:
116 women (50.9% African American, median age 56 years) from two prospective longitudinal studies of adverse effects (AEs) of whole breast irradiation were included. All patients completed 1-year post-RT CD and CS ratings on a 0-10 scale with 10 indicating no difference between the breasts (CD) or being completely happy with breast cosmesis (CS). STRA and pBRA values were calculated from photographs and ultrasound images using ultrasound tissue characterization at baseline (pre-RT) and 1-year post-RT. Univariate and multivariate models evaluated relationships between PROs and objective pBRA and STRA measurements, along with other clinical factors and validated measures of behavioral comorbidities.Results:
The 1-year PRO CD was inversely associated with increases in both 1-year pBRA (ß = -0.11, p < 0.001) and 1-year STRA (ß = -1.73, p < 0.001), indicating that lower PRO scores (more breast difference) reflected objective measures of increased radiation-induced changes in the affected vs. unaffected breast. Black patients [ß = -2.08, p < 0.001], obese patients (BMI >30) [ß = -2.29, p < 0.001], and those with poor sleep quality (PSQI >5) [ß = -1.53, p < 0.02] were more likely to notice a breast difference at 1 year. Among these factors, higher pBRA remained significant [ß = -0.09, p < 0.001] in the multivariate model and continued to predict for more patient perceived differences in the irradiated vs. nonirradiated breast. No variables significantly associated with CS, including pBRA and STRA (all p =0.05). However, a trend in association between depression (IDS-SR> 26) and lower CS scores was observed (ß = 1.51, p = 0.052).Conclusion:
One-year post-RT, CD reflected objective measures of pBRA, the only significant variable in the multivariate model that predicted for lower CD scores, indicating that breast asymmetry was a driver of this PRO. Depression may influence CS more than objective measures of radiation-induced AEs in the breast. Larger studies examining the influence of patient, tumor, and treatment factors on perception of breast cosmesis are needed.