DURHAM, NC — As many as 40% of breast cancer survivors are dissatisfied after breast reconstruction due to unexpected outcomes that don’t meet personal preferences.
That could be mitigated by identifying what attributes patients value when considering surgery. In addition, according to the study led by researchers from Duke University and the Durham, NC, VA Healthcare System, the information could improve shared decision-making between clinicians and patients.
Noting that adaptive choice-based conjoint (ACBC) analysis can elicit individual-level treatment preferences, the study team sought to identify which attributes of breast reconstruction are most important to women considering surgery. In JAMA Surgery, the researchers also described how the attributes differ between patients who prefer flap vs implant reconstruction.1
The web-based, cross-sectional study was conducted from March 1, 2022, to Jan. 31, 2023, at Duke University and between June 1 and December 31, 2022, through the Love Research Army (affiliated with the Dr. Susan Love Foundation for Breast Cancer Research) with Adaptive Choice-Based Conjoint (ACBC) analysis. Participants, who had a mean age of 46.3, were 105 women at Duke University with a new diagnosis of or genetic predisposition to breast cancer who were considering mastectomy with reconstruction and 301 women with a history of breast cancer or a genetic predisposition as identified through the Love Research Army registry.
Defined as the main outcomes and measures were relative importance scores, part-worth utility values, and estimated maximum acceptable risks.
Results indicate that the attribute considered most important was the risk of abdominal morbidity (mean [SD] relative importance [RI], 28% [11%]), followed by chance of major complications (RI, 25% [10%]), number of additional operations (RI, 23% [12%]), appearance of the breasts (RI, 13% [12%]), and recovery time (RI, 11% [7%]).
“Most participants (344 [85%]) preferred implant-based reconstruction; these participants cared most about abdominal morbidity (mean [SD] RI, 30% [11%]), followed by the risk of complications (mean [SD], RI, 26% [11%]) and additional operations (mean [SD] RI, 21% [12%]),” the researchers pointed out. “In contrast, participants who preferred flap reconstruction cared most about additional operations (mean [SD] RI, 31% [15%]), appearance of the breasts (mean [SD] RI, 27% [16%]), and risk of complications (mean [SD] RI, 18% [6%]).”
The study noted that the factors independently associated with choosing flap reconstruction included being married (odds ratio [OR], 2.30 [95% CI, 1.04-5.08]; P = .04) and higher educational level (college education; OR, 2.43 [95% CI, 1.01-5.86]; P = .048); having an income level of greater than $75 000 was associated with a decreased likelihood of choosing the flap profile (OR, 0.45 [95% CI, 0.21-0.97]; P = .01). The authors advised that respondents who preferred flap appearance were willing to accept a mean (SD) increase of 14.9% (2.2%) chance of abdominal morbidity (n = 113) or 6.4% (4.8%) chance of complications (n = 115).
“This study provides information on how women value different aspects of their care when making decisions for breast reconstruction,” the researchers concluded. “Future studies should assess how decision aids that elicit individual-level preferences can help tailor patient-physician discussions to focus preoperative counseling on factors that matter most to each patient and ultimately improve patient-centered care.”
Shammas RL, Hung A, Mullikin A, et al. Patient Preferences for Postmastectomy Breast Reconstruction. JAMA Surg. 2023;158(12):1285–1292. doi:10.1001/jamasurg.2023.44
