Impact of breast cancer therapy on body image and physical well-being – analysis of patient-reported outcomes

Hintergrund: Mit der Mastektomie und der brusterhaltenden Therapie stehen beim Mammakarzinom zwei bezüglich der onkologischen Sicherheit gleichwertige therapeutische Strategien zur Verfügung. Vor dem Hintergrund verbesserter Überlebensraten sollte der langfristigen Lebensqualität betroffener Frauen eine entscheidende Rolle in der individualisierten Therapieentscheidung und weiteren Versorgung zukommen. Ziel dieser Arbeit war es, anhand der Analyse von Patient-Reported Outcomes (PRO) die Auswirkungen der verschiedenen Therapien des Mammakarzinoms auf das Körperbild und das körperliche Wohlbefinden differenziert zu erfassen. Methodik: Zwischen 11/2016 und 04/2020 wurden bei 325 Mammakarzinompatientinnen präoperativ sowie 0,5, 1,5, 3, 6, 9, 12, 18, 24 Monate und anschließend jährlich nach brusterhaltender Operation (BEOP) (n=212), alleiniger Mastektomie (MA) (n=27) und Mastektomie mit (verzögerter) Sofortrekonstruktion (MSR) (n=86) elektronisch PRO mittels EORTC QLQ-C30, QLQ-BR23 und BREAST-Q prospektiv erhoben. Mit einem gemischten linearen Regressionsmodell wurde der Einfluss der Art der Brustoperation, der (neo-)adjuvanten Chemo-, Radio- und endokrinen Therapie sowie ausgewählter Kovariablen auf den Körperbild-, Brust-, Armsymptome-, Schmerz- und Körperliche-Funktionsfähigkeit-Score im Zeitverlauf analysiert. Ergebnisse: Unter Kontrolle für relevante Kovariablen im Regressionsmodell nahm auf alle Scores außer die Brustsymptome unmittelbar postoperativ die BEOP den geringsten und die MA den größten schädigenden Einfluss, während der Einfluss der MSR jeweils dazwischen lag (Körperbild -5 vs. -7 vs. -19 Punkte, je p<0,05; körperliche Funktionsfähigkeit -7 vs. -7 vs. -17 Punkte, je p≤0,0001; Armsymptome +14 vs. +20 vs. +26 Punkte, je p≤0,0001; Schmerz +10 vs. +16 vs. +19 Punkte, je p<0,05). Im Zeitverlauf zeigte sich ein nicht statistisch signifikanter Trend einer langsameren Erholung des Körperbildes und der körperlichen Funktionsfähigkeit nach MSR. Die Chemotherapie war mit einer initialen Verschlechterung des Körperbildes (-22 Punkte), der körperlichen Funktionsfähigkeit (-17 Punkte) und Schmerzen (+11 Punkte) assoziiert, im Zeitverlauf jedoch mit einer Erholung des Körperbildes und der Funktionsfähigkeit (je p<0,05). Die Radiotherapie war im Zeitverlauf mit einer ausbleibenden Erholung der Scores zur Messung des körperlichen Wohlbefindens assoziiert (je p<0,05). Schlussfolgerung: Wenn möglich, sollte Patientinnen eine BEOP angeboten werden, um das Körperbild und körperliche Wohlbefinden zum Zeitpunkt der Operation sowie im Zeitverlauf zu schonen. Es sollte diskutiert werden, dass eine MSR im langfristigen Verlauf das Körperbild und die körperliche Funktionsfähigkeit negativ beeinflussen könnte. Die Beeinträchtigung der Lebensqualität vor allem kurzfristig durch die Chemotherapie sowie im langfristigen Zeitverlauf nach einer Radiotherapie sollte ebenfalls im Rahmen der prä- und postoperativen onkologischen Betreuung thematisiert werden.Background: With mastectomy and breast-conserving therapy, two equally safe therapeutical strategies are available for the treatment of breast cancer. With regard to improved survival rates, women’s long-term quality of life should play a critical role in individualized treatment decision-making and subsequent patient care. The present analysis aimed at clarifying the impact of different breast cancer therapies on body image and physical well-being by analyzing patient-reported outcomes (PRO). Methods: Between 11/2016 and 04/2020 electronic PRO were prospectively collected using EORTC QLQ-C30, QLQ-BR23 and BREAST-Q in 325 breast cancer patients preoperatively as well as 0.5, 1.5, 3, 6, 9, 12, 18, 24 months and annually thereafter after breast-conserving surgery (BCS) (n=212), mastectomy alone (MA) (n=27) and mastectomy with (delayed-)immediate breast reconstruction (M+IBR) (n=86). A mixed linear regression model was used to analyze the impact of type of breast surgery, (neo-)adjuvant chemo-, radio- and endocrine therapy, and selected covariables on body image, breast symptoms, arm symptoms, pain and physical functioning scores over time. Results: Controlling for relevant covariables in the regression model, immediately after surgery BCS had the least damaging influence and MA the most damaging influence on all scores except breast symptoms, while the influence of M+IBR was intermediate (body image -5 vs. -7 vs. -19 points, each p<0.05; physical functioning -7 vs. -7 vs. -17 points, each p≤0.0001; arm symptoms +14 vs. +20 vs. +26 points, each p≤0.0001; pain +10 vs. +16 vs. +19 points, each p<0.05). There was a non-statistically significant trend towards slower recovery of body image and physical functioning over time after M+IBR. Chemotherapy was associated with initial worsening of body image (-22 points), physical functioning (-17 points) and pain (+11 points), but also with a subsequent recovery over time of body image and physical functioning (each p<0.05). Radiotherapy was associated with the absence of recovery over time in all scores measuring physical well-being (each p<0.05). Conclusion: When possible, patients should be offered BCS to preserve body image and physical well-being at the time of surgery and over time. It should be discussed that M+IBR could negatively affect body image and physical functioning in the long term. Additional impairment of quality of life, in the short term due to chemotherapy as well as in the long term after radiotherapy, should be addressed as part of pre- and postoperative oncological patient care as well

Management of pineal region tumors in a pediatric case series

Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendoscopic biopsy and endoscopic third ventriculocisternostomy (ETV) in patients with pineal region tumors between 2006 and 2019 in a single-center retrospective cross-sectional study with regard to diagnostic yield, hydrocephalus treatment, as well as impact on further antitumoral management. Out of 28 identified patients, 23 patients presented with untreated hydrocephalus and 25 without histological diagnosis. One patient underwent open biopsy, and 24 received a neuroendoscopic biopsy with concomitant hydrocephalus treatment if necessary. Eighteen primary ETVs, 2 secondary ETVs, and 2 ventriculoperitoneal shunts (VPSs) were performed. Endoscopic biopsy had a diagnostic yield of 95.8% (23/24) and complication rates of 12.5% (transient) and 4.2% (permanent), respectively. ETV for hydrocephalus management was successful in 89.5% (17/19) with a median follow-up of more than 3 years. Following histological diagnosis, 8 patients (28.6%) underwent primary resection of their tumor. Another 9 patients underwent later-stage resection after either adjuvant treatment (n = 5) or for progressive disease during observation (n = 4). Eventually, 20 patients received adjuvant treatment and 7 were observed after primary management. One patient was lost to follow-up. Heterogeneity of pineal region tumor requires histological confirmation. Primary biopsy of pineal lesions should precede surgical resection since less than a third of patients needed primary surgical resection according to the German pediatric brain tumor protocols. Interdisciplinary decision making upfront any treatment is warranted in order to adequately guide treatment

How breast cancer therapies impact body image – real-world data from a prospective cohort study collecting patient-reported outcomes

Abstract Background In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. Methods EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 – 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. Results BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p  0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). Conclusions Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care