B22
A multi centre prospective longitudinal study establishing level II evidence of health related quality of life after types of immediate latissimus dorsi (LD) breast reconstruction
Helen Thomon1, Judith Mills2, Alex Reece-Smith1, John Benson3, Marcus Galea4, Penny McManus5, Stewart Nicolson6, Eva Weiler-Mithoff7, Zen Rayter1, Michelle Greenslade1, Zoe Winters1
1University Hospitals Bristol NHS Foundation, Bristol, UK, 2The Institute of Cancer Research, Sutton, UK, 3Addenbrooke's Hospital Cambridge NHS Foundation Trust, Cambridge, UK, 4Western General NHS Foundation Trust, Swindon, UK, 5Hull & East Yorkshire Hospitals NHS Trust, Hull, UK, 6York Hospitals NHS Trust, UK, 7NHS Greater Glasgow & Clyde, UK
Background
NICE recommends that the majority of women recommended to undergo
mastectomy should be offered immediate breast reconstruction with its potential
benefits to improve health related quality of life (HRQL). A systematic
review shows poor and conflicting evidence with a lack of hard data to best
inform both clinicians and their patients. Our aim was to evaluate the effects
of implant-assisted LD (LDI) versus autologous LD (ALD) breast reconstruction
on HRQL over 12 months.
Method
An MREC approved prospective longitudinal cohort study involving 6 centres
commenced in early 2007. Serial patient reported outcome measures using
the EORTC C30 (global QL, physical functioning, fatigue, pain), BR-23 (breast
and arm symptoms), 10 item Body Image Scale (BIS) and HADS, were completed
pre-operatively and at 3, 6, 12 and 24 months after surgery. A
significance for HRQL domains was set at P= 0.01.
Results
121 patients (60 ALD, 61 LDI) were recruited to the study with a mean
age of 50 years (range 22-70). Compliance with questionnaires at all time
points was between 85-90%. There were found to be no significant
differences in HRQL domains between LDI and ALD at the 5 time points analysed.
Significant improvements over time were seen for overall HRQL, fatigue
(p<0.001), breast (p=0.04) and arm symptoms (p=0.001). The study is ongoing
in terms of 24 month follow up and the evaluation of RT.
Conclusion
There is an important need for cumulative clinical evidence in this field
on which to base patient informed consent and clinical recommendations.
