Quality of Life in Patients with Breast Cancer following Breast Conservation Surgery: A Systematic Review and Meta-Analysis
Yue Li, Jianming Guo, Yuan Sui, Baihui Chen, Dalin Li, Jiakang Jiang
Abstract
To evaluate the health-related quality-of-life (QOL) outcomes in surgical breast cancer survivors who received breast conservation therapy (BCT) compared to mastectomy, we utilized a systematic review to conduct observational studies of QOL in patients with breast cancer following breast conservation therapy from their inception until October 2021. The PubMed, the Cochrane Library, and the Web of Science databases were systematically searched to retrieve the observational studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were applied as an effect estimate and calculated using Stata 15 software. Nine studies comprising 2301 patients were included. The results showed that no significant differences compared to mastectomy were detected for global health status ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>=</a:mo> <a:mn>0.971</a:mn> </a:math> and <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.613</c:mn> </c:math> ), physical function ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.099</e:mn> </e:math> ), emotional function ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.096</g:mn> </g:math> ), cognitive function ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>=</i:mo> <i:mn>0.377</i:mn> </i:math> ), social function ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>=</k:mo> <k:mn>0.602</k:mn> </k:math> ), sexual functioning ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo>=</m:mo> <m:mn>0.072</m:mn> </m:math> ), and sexual enjoyment ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>P</o:mi> <o:mo>=</o:mo> <o:mn>0.142</o:mn> </o:math> ), while role function ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo>=</q:mo> <q:mn>0.036</q:mn> </q:math> ), body image ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mi>P</s:mi> <s:mo>=</s:mo> <s:mn>0.000</s:mn> </s:math> ), and future perspective ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>P</u:mi> <u:mo>=</u:mo> <u:mn>0.012</u:mn> </u:math> ) showed a significant difference for BCT when compared to mastectomy. When compared to breast reconstruction (BR), the BCT group was inferior at physical function ( <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>P</w:mi> <w:mo>=</w:mo> <w:mn>0.002</w:mn> </w:math> ) and cognitive function ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mi>P</y:mi> <y:mo>=</y:mo> <y:mn>0.040</y:mn> </y:math> ) but superior at body image ( <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mi>P</ab:mi> <ab:mo>=</ab:mo> <ab:mn>0.001</ab:mn> </ab:math> ). When used the Functional Assessment of Cancer Therapy (FACT) tool, BCT has better results in physical function ( <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:mi>P</cb:mi> <cb:mo>=</cb:mo> <cb:mn>0.000</cb:mn> </cb:math> ), emotional function ( <eb:math xmlns:eb="http://www.w3.org/1998/Math/MathML" id="M16"> <eb:mi>P</eb:mi> <eb:mo>=</eb:mo> <eb:mn>0.000</eb:mn> </eb:math> ), and social function ( <gb:math xmlns:gb="http://www.w3.org/1998/Math/MathML" id="M17"> <gb:mi>P</gb:mi> <gb:mo>=</gb:mo> <gb:mn>0.000</gb:mn> </gb:math> ) than mastectomy. QOL outcomes after BCT were better than mastectomy in body image, future perspective, and role function. BCT may be an acceptable option in the study setting for breast cancer patients who pursue high QOL.