Advancing breast cancer treatment: Proceedings from breast global webinar on patient-reported outcome measures in breast cancer
Year: 2023
Type: article
Abstract: PROCEEDINGS This proceedings article presents a summary of the BreastGlobal Webinar on patient-reported outcome measures (PROMS) in breast cancer held on March 11, 2023, in celebration of International Women’s Day. The webinar focused on the use of PROMs in breast surgery and other discussed other quality-of-life scales for patients with breast cancer. The webinar was divided into three talks followed by a neatly moderated panel discussion. The first talk by Dr. Andrea Pusic provides an overview of the development and utilisation of the BREAST-Q measure, emphasising the importance of patient perspectives and the global impact of the measure in clinical research and patient care. The second talk by Prof. Jerome Pereira discusses the development and implementation of PROMs in oncoplastic breast surgery through a national audit, highlighting key findings and the potential of PROMs as a tool for improving current practices. The third talk by Prof. Tabassum Wadasadawala explores the comparison of early cosmetic outcomes between standard and oncoplastic breast conservation surgery, focusing on the effects of radiation therapy and the importance of cosmesis. The webinar was co-moderated by Dr. C.B. Koppiker and Dr. Shalaka Joshi. The article also includes description of the panel discussion involving invited panellists Dr. Nita Nair, and Savita Goswami, speakers, moderators, and BreastGlobal Co-chairs that addresses challenges and considerations in implementing PROMs and acknowledges the socio-cultural aspects affecting questionnaire acceptance. Overall, the proceedings shed light on the significance of PROMs in improving patient care and understanding the outcomes of breast surgery procedures. Talk 1: Dr. Andrea Pusic: The BREAST-Q in Clinical Research and Patient Care (Chief, Division of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital Co-Director, Patient-Reported Outcomes, Value, and Experience (PROVE) Centre, Brigham and Women’s Hospital Joseph E. Murray Professor of Surgery, Harvard Medical School) Introduction Dr. Andrea Pusic in her talk presented an overview of the development and utilisation of the BREAST-Q patient outcome measure. The talk highlighted the importance of patient perspective in breast surgery and the evolution of outcome research in the field. Development of BREAST-Q Dr. Pusic described the collaborative effort between herself, Dr. Ann Clawson, an expert in quality of measurements, and Dr. Stefan Cano, a psychometrician, in developing the BREAST-Q outcome measure. The team recognised the significance of patient-reported measures in plastic surgery outcomes and emphasised the inclusion of various patient populations in the modules. Key features of Breast Q patient-reported outcome measures The BREAST-Q comprises independently functioning scales that measure specific constructs or domains related to breast surgery outcomes. Dr. Pusic emphasised the flexibility of the measure, allowing researchers to select specific scales for their studies, making it less burdensome for patients. Additionally, she discussed the addition of new scales, such as breast sensation, to capture evolving surgical techniques and patient needs. Clinical application and global reach Dr. Pusic discussed the extensive use of BREAST-Q in clinical care and research studies worldwide. She highlighted its availability free of charge for researchers and clinical practitioners. The measure has been translated into 40 languages and used in over 77 countries, with over 4000 licensed users and more than 700 publications. Case study: Mastectomy reconstruction outcome consortium study Dr. Pusic presented a study involving 1632 patients who underwent breast reconstruction after mastectomy. The study used the BREAST-Q to assess complications and patient-reported outcomes. Results showed differences in satisfaction, sexual well-being, and physical and psychosocial aspects between implant and autologous reconstruction, with autologous faring better in long-term outcomes.[1] Enhancing shared decision-making The talk emphasised the use of PROMs, such as BREAST-Q, to help patients understand post-surgery expectations and make informed decisions about their treatment options. Dr. Pusic discussed the importance of long-term recovery expectations, counselling patients about physical well-being, and the impact of breast surgery on daily functioning. Clinical care and patient needs Dr. Pusic shared examples of how PROMs, like BREAST-Q, have helped identify unmet patient needs in clinical care. By closely monitoring patient scores, clinicians were able to address issues such as hernias and provide appropriate interventions or resources to improve patient well-being. Conclusion Dr. Pusic concluded her talk by emphasising the value of PROMs in advancing breast surgery outcomes and shared decision-making. The BREAST-Q has proven to be a valuable tool in assessing patient perspectives and understanding the evolving field of breast surgery. The global reach and widespread adoption of BREAST-Q underscore its significance in research and clinical practice, ultimately improving patient care and quality of life. TALK 2: PROF. JEROME PEREIRA: DEVELOPING AND IMPLEMENTING PROMS FOR ONCOPLASTIC BREAST SURGERY (CONSULTANT ONCOPLASTIC BREAST SURGEON AT JAMES PAGET UNIVERSITY HOSPITALS NHS FOUNDATION TRUST AND HONORARY PROFESSOR OF SURGERY COURSE DIRECTOR FOR MASTERS IN ONCOPLASTIC BREAST SURGERY, UNIVERSITY OF EAST ANGLIA, NORWICH PROGRAM DIRECTOR FOR MULTIPLE SPECIALIST E-LEARNING MASTERSHIP PROGRAMS AT THE UNIVERSITY OF EAST ANGLIA, NORWICH LEAD FOR TRAINING, MENTORSHIP, AND QUALITY ASSURANCE OF PROGRAMS AT BREASTGLOBAL) INTRODUCTION Prof. Jerome Pereira shared insights from UK national audit on oncoplastic breast surgery.[2] The talk focused on the background of the audit, its aims, methodology, key findings, and the potential of PROMs as a tool for current practice. METHODOLOGY AND KEY FINDINGS Prof. Pereira recounts his personal journey in setting up a patient outcome audit and surgical audit to assess the safety and effectiveness of his own techniques. He explains how the audit expanded into a regional study involving multiple hospitals, with the objective of eventually conducting a nationwide audit. The data collected included patient satisfaction, preoperative and postoperative care satisfaction, cosmetic results, and surgical complications.[2] THE NATIONAL AUDIT ON MASTECTOMY RECONSTRUCTION The speaker described the objectives of the national audit, which focused on evaluating current practices, measuring surgical outcomes, and assessing patient-reported outcomes. The audit employed a multimodal approach, including a baseline audit, organisation surveys, focus groups, and prospective data collection. The inclusion criteria encompassed mastectomy patients, those with immediate and delayed reconstruction, and excluded patients who could not communicate in English or were below 16 years of age.[2] RESULTS AND IMPLICATIONS The talk presents the outcomes of the national audit, which recruited over 18,000 patients from 150 English trusts, private hospitals, and six Welsh hospitals. Prof. Pereira highlights the wide variation in immediate reconstruction rates across units and emphasises the importance of effective communication and patient information provision. The findings also reveal areas for improvement, such as reducing postoperative pain and surgical complications.[2] ROLE OF PATIENT-REPORTED OUTCOME MEASURES IN IMPROVING PRACTICE The speaker underscores the value of PROMs in identifying areas for improvement and assessing patient satisfaction. He emphasises the need to incorporate PROMs into standard operating procedures and designate a single point of leadership for effective implementation. Prof. Pereira stresses that the use of PROMs should extend beyond individual practices and contribute to national guidelines for best practices in breast reconstruction. CONCLUSION Prof. Jerome Pereira’s talk provides valuable insights into the development and implementation of PROMs for oncoplastic breast surgery through a national audit. The findings highlight the importance of evaluating surgical outcomes and patient experiences to enhance the quality of care. The article concludes by encouraging oncoplastic surgeons to embrace PROMs and think innovatively to address challenges in breast conservation surgery. TALK 3: PROF. TABASSUM WADASADAWALA: COMPARISON OF EARLY COSMETIC OUTCOMES OF STANDARD VERSUS ONCOPLASTIC BREAST CONSERVATION SURGERY: A MATCHED PAIR ANALYSIS (PROFESSOR AND CONSULTANT RADIATION ONCOLOGIST AT TATA MEMORIAL CENTRE) In her presentation, Prof. Tabassum Wadasadawala focused on the effects of radiation therapy and oncoplastic breast surgery on early cosmetic outcomes. She highlighted the importance of cosmesis as an essential endpoint in breast conservation surgery, particularly due to the known tendency of standard lumpectomy to worsen cosmetic outcomes when combined with postoperative radiotherapy. METHODS In this prospective longitudinal study, a total of 370 consecutive patients who underwent breast conservation surgery and received radiotherapy at Tata Memorial Hospital were enrolled. The study period coincided with the coronavirus disease-2019 (COVID-19) pandemic, spanning from April 2020 to December 2021. Both subjective and objective methods were used to assess cosmetic outcomes, including baseline cosmesis ratings evaluated by physicians and patients. RESULTS Baseline data showed that 70% of patients and 80% of doctors rated the overall cosmetic outcome as excellent to good. Factors such as increasing breast volume, radiotherapy parameters (planning target volume [PTV], clinical target volume [CTV], volume, and breast tumour ratio), and re-excision rate had an impact on baseline cosmesis. Multivariate analysis revealed that these factors continued to be significant in physician ratings, whereas patient ratings were influenced by the proportion of breast tumours and the presence of postoperative complications. PROPENSITY SCORE MATCHING To address the differences in surgical approaches, propensity score matching was performed, considering factors such as menopausal status, clinical tumour stage, breast CT volume, hormonal therapy or chemotherapy, and radiation technique. The incidence of postoperative complications was found to be significantly higher in the oncoplastic surgery group (9%) compared to the standard lumpectomy group (3%). COSMESIS ANALYSIS Physicians rated oncoplastic surgery higher in terms of cosmesis compared to standard lumpectomy. Patient assessments showed consistent cosmesis ratings at baseline and after six months, with approximately 75% to 80% of patients in the excellent to good category. However, a change in cosmesis ratings was observed in one-third of patients when comparing the baseline assessment with the six-month evaluation. Factors such as type of incision and hormone therapy were found to be significant in influencing changes in cosmesis. RADIOTHERAPY PARAMETERS Breast size was the only significant factor identified in the analysis of radiotherapy parameters, with larger breast sizes (more than 1000 cc) having a 2.6 times higher probability of worsening cosmetic outcomes. Other radiotherapeutic variables, such as boost type, dose fluctuation, or technique, did not significantly impact cosmesis. CONCLUSION The study found that a significant proportion of patients (74%–80%) achieved excellent to good cosmesis at baseline. Factors such as breast size, breast size to tumour ratio, type of cavity, re-excision rate, and postoperative complications influenced baseline cosmesis. A one-third incidence of worsening cosmesis was observed at six months, with factors such as incision type, hormone therapy, and breast size affecting these changes. Long-term follow-up and research are necessary to understand the impact of different radiotherapeutic variables on cosmesis in combination with surgery. Future analysis will focus on patient follow-up and the collection of updated data for long-term results. During the question-and-answer session, all three speakers addressed queries related to the challenges of implementing PROMs in different healthcare settings, the integration of PROMs into routine clinical practice, and the potential role of technology in facilitating data collection and analysis. The BreastGlobal Webinar concluded with a panel discussion. The webinar discussion focused on the use of PROMs in the treatment of breast cancer, particularly focusing on the Indian scenario. Dr. Shalaka Joshi and Dr. C.B. Koppiker, co-moderated the discussion and emphasised the importance of understanding and addressing the quality of life of patients with breast cancer. THE PANEL DISCUSSION The discussion panel included Dr. Andrea Pusic, Prof. Jerome Pereira, Dr. Tabassum Wadasadawala, Dr. Chetan Deshmukh, Prof. Nita Nair, and Dr. Savita Goswami. Prof. Kothari explained that time and administration were barriers to the routine use of PROMs, but efforts were being made to implement electronic versions for better efficiency. Prof. Pereira mentioned that although PROMs were advised, their systematic use was hindered by workloads, staffing shortages, and bureaucracy in the UK. Dr. Nita emphasised the importance of using standard PROMs, such as EORTC and FACT questionnaire and focusing on breast-specific outcomes. She appreciated Dr. Andrea’s team’s efforts to develop the PROMs questionnaire, highlighting the benefits of understanding patient concerns and adjusting treatment accordingly. Prof. Chintamani shared the challenges faced in implementing PROMs in India and the need for tailoring the questionnaire to suit the population. He mentioned customising the use of the BREAST-Q questionnaire in their oncoplastic work. Dr. Tabassum discussed the linguistic validation of the BREAST-Q questionnaire in Hindi and Marathi and the challenges faced by some patients in filling out the questionnaire independently. She stressed the importance of collecting longitudinal data to assess postoperative outcomes and long-term effects. The panel also discussed the socio-cultural aspects affecting the understanding and acceptance of the questionnaire by patients. They acknowledged the challenges faced in both Western and Indian healthcare systems, including limited resources, long waiting times, and disparities in access to care. Dr. Joshi raised the question of whether the BREAST-Q questionnaire, specifically the breast conservation module, would be sufficient for assessing outcomes in oncoplastic procedures. Dr. Andrea explained that the BREAST-Q questionnaire focused on surgery and radiation outcomes, whereas other questionnaire covered symptoms associated with chemotherapy and menopausal symptoms. In conclusion, all the Co-chairs, speakers, and panellists expressed their optimism about the future of PROMs and their potential to enhance patient-centred care in breast surgery. They emphasised the importance of continued research, collaboration, and education to ensure the successful implementation and utilisation of PROMs in clinical practice. Overall, the BreastGlobal Webinar provided valuable insights into the development, implementation, and clinical applications of PROMs in breast surgery. It highlighted the significance of incorporating the patient’s perspective, improving shared decision-making, and driving quality improvement in breast surgery outcomes. It also addressed the challenges and barriers faced in implementing PROMs in different healthcare settings, emphasising the need for tailored approaches and increased uptake. Acknowledgement The authors would like to express their gratitude for unrestricted research support (Grant no. #GC2528) provided by Bajaj Auto Ltd to Prashanti Cancer Care Mission (PCCM), through which BreastGlobal platform and activities are conducted. We are very thankful to PCCM-CTCR staff for their invaluable support in making BreastGlobal webinars a huge success. We acknowledge the media support and technical help provided by our technical partners MixOrg, India. We greatly value the leadership and persistent support of BreastGlobal co-chairs, Dr. Ashutosh Kothari and Prof. Chintamani. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Breast Global Journal
DOI: 10.4103/bgj.bgj_7_23
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4390601697