Patient Reports on Aesthetic Outcomes of Breast Cancer Surgery Remain the Gold Standard

Patients with breast cancer tend to score postoperative aesthetic outcomes (AOs) higher than both expert panels and computer software, according to study results published in JAMA Network Open.

A group of researchers compared patient-reported outcome measures (PROMs) after breast cancer surgery with 2 other evaluation modalities: expert panel and computerized evaluations. PROMs are generally considered the gold standard of AO assessment.

They conducted a meta-analysis of 10 observational studies involving a total of 3083 patients who underwent surgical treatment for breast cancer. AO modalities in this network meta-analysis included 2111 PROMs, expert panel assessments of 1399 patient images, and Breast Cancer Conservation Treatment cosmetic results (BCCT.core) assessments of 961 anterior-posterior patient images.

The primary outcome was modality discordance from PROMs assessed with 4-point Likert responses across PROMs, expert panel assessment, and BCCT.core evaluation of AOs. Likert responses were grouped as “excellent,” “very good,” “satisfactory,” or “bad.”

Both the expert panel and computer assessment modalities consistently undergraded AOs in comparison with PROMs, regardless of their Likert response groupings. Additionally, the computerized tool underrated AOs compared with expert panels; however, the difference was not significant in any of the Likert response groupings.

PROMs can be subjective, with many other factors — such as adverse effects, financial toxicity, race and ethnicity, body image perception, and sexuality — playing a role in patient reports on AO that are not well represented in all AO modalities. However, expert panel and computerized assessments also may be affected by other factors. So, despite the subjectivity of PROMs, they remain the benchmark for AO assessment; a position supported by those on the panel of experts.

As such, patients might benefit from a novel combined approach that incorporates the best elements and mitigates any weaknesses in AO assessments. The development of a validated standardized AO tool tailored to breast cancer patients could both improve the quality and accuracy of AO reporting and ultimately improve patients’ experience, the researchers suggested.

“Given the consistent underestimation of AOs by both expert panels and previously validated software compared with patient appraisal, further studies to define a multimodal approach of AO scoring, benchmarked against the gold standard of patients’ own AO assessments, should be pursued,” the researchers concluded.

“In that effort, PROMs should remain the core of the novel integrated AO assessment tool to allow the independent voice of patients to become systemically integrated and in turn shape future clinical practice.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Kastora SL, Holmquist A, Valachis A, et al. Outcomes of different quality of life assessment modalities after breast cancer therapy: a network meta-analysis. JAMA Netw Open. 2023;6(6):e2316878. doi:10.1001/jamanetworkopen.2023.16878