Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors.

Autor: Smith BD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. bsmith3@mdanderson.org.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. bsmith3@mdanderson.org., Lei X; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Diao K; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Xu Y; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Shen Y; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Smith GL; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Giordano SH; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., DeSnyder SM; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Hunt KK; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Teshome M; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Jagsi R; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Shaitelman SF; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Peterson SK; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Swanick CW; Department of Radiation Oncology, Orlando Health UF Health Cancer Center, Orlando, FL, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2020 Apr; Vol. 27 (4), pp. 1013-1022. Date of Electronic Publication: 2020 Jan 08.
DOI: 10.1245/s10434-019-08165-2
Abstrakt: Background: The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions.
Methods: We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1.
Results: Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists.
Conclusions: Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.
Databáze: MEDLINE
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