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Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis

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Abstract

The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI—confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI −0.07, 0.37), emotional health (k = 13; −0.08, 95% CI − 0.41, 0.25), global health (k = 7; 0.1, 95% CI − 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI − 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.

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Authors and Affiliations

  1. Department of General Surgery, St George’s University Hospital, London, UK

    Sadaf Zehra

  2. Royal College of Surgeon Ireland, Dublin, Ireland

    F. Doyle

  3. Mater Misericordiae University Hospital, Dublin, Ireland

    M. Barry, S. Walsh & M. R. Kell

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  1. Sadaf Zehra
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Zehra, S., Doyle, F., Barry, M. et al. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer 27, 534–566 (2020). https://doi.org/10.1007/s12282-020-01076-1

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