Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2022 Dec;29(13):7964-7973. doi: 10.1245/s10434-022-12477-1. Epub 2022 Sep 23.
Patient-reported outcome measures (PROM) are used to assess value-based care. Little is known as to whether PROM response in breast cancer reflects the diverse patient population. The BREAST-Q, a validated measure of satisfaction and quality of life, and Recovery Tracker, a postoperative assessment tool, are PROM routinely delivered to all patients undergoing breast surgery at our institution. Here we determine whether response to PROM differs by age, race, language, or disease stage.
All patients who had a breast operation between January 2020 and July 2021 were requested to complete the BREAST-Q and Recovery Tracker. Non-responders did not complete the PROM at any timepoint; responders completed 1 or more. Primary outcomes included rates of non-response versus response overall.
Of 6374 patients identified, 5653 (88.7%) responded to either PROM [4366/4751 (91.9%) BREAST-Q; 2746/3384 (81.1%) Recovery Tracker]. On univariate analysis, non-responders were older (60 years versus 55 years, p < 0.001) and more often non-English speaking (p < 0.001), Hispanic ethnicity (p = 0.031), and Black race (p < 0.001), versus responders. On multivariate analysis, non-responders were significantly more often Black race and non-English speaking (p < 0.001). Non-English speakers were significantly less responsive among all ethnicities and races except Black race. Although breast cancer stage did not reach significance for response, patients with malignant disease and those receiving neoadjuvant chemotherapy responded more often.
Our findings demonstrate high patient engagement using 2 different PROM following breast surgery, but suggest that PROM results may not reflect the experience of the entire breast cancer population. Care process changes based solely on PROM should consider these findings to ensure that the views of the entire spectrum of patients with breast cancer are represented.
患者报告的结果测量（PROM）用于评估基于价值的护理。对于 PROM 在乳腺癌中的反应是否反映了多样化的患者群体，知之甚少。BREAST-Q 是一种经过验证的满意度和生活质量衡量标准，Recovery Tracker 是一种术后评估工具，这两种 PROM 都在我们机构常规提供给所有接受乳房手术的患者。在这里，我们确定 PROM 的反应是否因年龄、种族、语言或疾病阶段而不同。
所有在 2020 年 1 月至 2021 年 7 月期间接受乳房手术的患者都被要求完成 BREAST-Q 和 Recovery Tracker。未回复者在任何时间点都未完成 PROM；回复者完成了 1 次或更多次。主要结果包括总体非回复者与回复者的比例。
在确定的 6374 名患者中，有 5653 名（88.7%）对 PROM 做出了回应[4366/4751（91.9%）的 BREAST-Q；2746/3384（81.1%）的 Recovery Tracker]。在单因素分析中，非回复者年龄较大（60 岁与 55 岁，p<0.001），且更常为非英语使用者（p<0.001）、西班牙裔（p=0.031）和黑人（p<0.001），而非回复者。在多因素分析中，非回复者更常为黑人且非英语使用者（p<0.001）。除了黑人种族，非英语使用者在所有种族和民族中的反应都明显较低。尽管癌症分期对反应没有达到显著水平，但患有恶性疾病和接受新辅助化疗的患者反应更频繁。
我们的研究结果表明，在接受乳房手术后使用两种不同的 PROM 可实现较高的患者参与度，但这表明 PROM 结果可能无法反映整个乳腺癌患者群体的体验。仅基于 PROM 的护理流程变更应考虑这些发现，以确保代表整个乳腺癌患者群体的意见。
