Physical well-being recovery trajectories by reconstruction modality in women undergoing mastectomy and breast reconstruction: Significant predictors and health-related quality of life outcomes

PLOS ONE RESEARCH ARTICLE Physical well-being recovery trajectories by reconstruction modality in women undergoing mastectomy and breast reconstruction: Significant predictors and health-related quality of life outcomes a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Cai Xu ID1,2*, Peiyi Lu3, André Pfob2,4, Andrea L. Pusic5, Jennifer B. Hamill ID6, Chris SideyGibbons1,2 1 Division of Internal Medicine, Section of Patient Centered Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America, 2 MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America, 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America, 4 Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany, 5 Department of Surgery, Patient-Reported Outcome Value & Experience (PROVE) Center, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States of America, 6 The Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, United States of America OPEN ACCESS * Citation: Xu C, Lu P, Pfob A, Pusic AL, Hamill JB, Sidey-Gibbons C (2023) Physical well-being recovery trajectories by reconstruction modality in women undergoing mastectomy and breast reconstruction: Significant predictors and healthrelated quality of life outcomes. PLoS ONE 18(7): e0289182. https://doi.org/10.1371/journal. pone.0289182 Editor: Shimpei Miyamoto, The University of Tokyo Graduate School of Medicine Faculty of Medicine: Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, JAPAN Abstract Objectives We sought to identify trajectories of patient-reported outcomes, specifically physical wellbeing of the chest (PWBC), in patients who underwent postmastectomy breast reconstruction, and further assessed its significant predictors, and its relationship with health-related quality of life (HRQOL). Received: May 4, 2023 Accepted: July 12, 2023 Published: July 28, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0289182 Copyright: © 2023 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Methods We used data collected as part of the Mastectomy Reconstruction Outcomes Consortium study within a 2-year follow-up in 2012–2017, with 1422, 1218,1199, and 1417 repeated measures at assessment timepoints of 0,3,12, and 24 months, respectively. We performed latent class growth analysis (LCGA) in the implant group (IMPG) and autologous group (AUTOG) to identify longitudinal change trajectories, and then assessed its significant predictors, and its relationship with HRQOL by conducting multinomial logistic regression. Results Of the included 1424 patients, 843 were in IMPG, and 581 were in AUTOG. Both groups experienced reduced PWBC at follow-up. LCGA identified four distinct PWBC trajectories (χ2 = 1019.91, p<0.001): low vs medium high vs medium low vs high baseline PWBC that was restored vs. not-restored after 2 years. In 76.63%(n = 646) of patients in IMPG and PLOS ONE | https://doi.org/10.1371/journal.pone.0289182 July 28, 2023 1 / 16 PLOS ONE Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files as S1 Data. Funding: This study is supported by National Cancer Institute Grant No. R01 CA152192 and in part by National Cancer Institute Support Grant No. P30 CA008748, but the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: Cai Xu No relationship to disclose. Peiyi Lu No relationship to disclose. André Pfob No relationship to disclose. Andrea L. Pusic Patents, Royalties, Other Intellectual Property: I am a codeveloper of BREAST-Q and receive royalty payments when it is used in forprofit industry-sponsored trials. Jennifer B Hamill No relationship to disclose. Chris Sidey-Gibbons No relationship to disclose. Our competing interests statement does not alter our adherence to PLOS ONE policies on sharing data and materials. Abbreviations: PRO, patient-reported outcome; HRQOL, health-related quality of life; MCID, minimal clinically important differences; IMPG, implant group; AUTOG, autologous group; PWBC, physical well-being of the chest; PMBR, postmastectomy breast reconstruction. Physical well-being recovery trajectories in breast cancer patients 62.99% (n = 366) in AUTOG, PWBC was restored after two years. Patients in IMPG exhibited worse PWBC at 3 months post-surgery than that in AUTOG. Patients with low baseline PWBC that did not improve at 2-year follow up (n = 28, 4.82% for AUTOG) were characterized by radiation following reconstruction and non-white ethnicity. In IMPG, patients with medium low-restored trajectory were more likely to experience improved breast satisfaction, while patients developing high-restored trajectories were less likely to have worsened psychosocial well-being. Conclusion Although more women in IMPG experienced restored PWBC after 2 years, those in AUTOG exhibited a more favorable postoperative trajectory of change in PWBC. This finding can inform clinical treatment decisions, help manage patient expectations for recovery, and develop rehabilitation interventions contributing to enhancing the postoperative quality of life for breast cancer patients. Introduction Health-related quality of life (HRQOL) following postmastectomy breast reconstruction (PMBR) for breast cancer patients has experienced an increase in interest as the number of breast reconstructions and bilateral mastectomies rises [1]. The Breast-Q questionnaire, as a validated and reliable patient-reported outcome (PRO) measurement developed for breast surgery [2], can be utilized to evaluate HRQOL across multiple domains, including breast satisfaction, physical well-being of the chest (PWBC), physical well-being of the abdomen, sexual well-being, and psychosocial well-being [3,4]. Women who receive PMBR demonstrate better breast-related body image compared to those who receive a mastectomy without reconstruction [3,5]. Cancer patients often experience functional deficits following treatment, which can limit their physical capacity [6]. Previous studies examining long-term effects of upper limb dysfunction show more than half of patients undergoing breast cancer surgery had upper quadrant dysfunction up to 6 (...truncated)