title: Cosmetic outcomes and complications reported by patients having undergone breast-conserving treatment.
abstract: OBJECTIVE
  Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate "excellent" or "good" cosmesis in >90% of patients treated with BCT.
  
  
  METHODS
  Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval.
  
  
  RESULTS
  Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. "Excellent" cosmesis was reported by 27% (n = 88), "Good" by 44% (n = 144), "Fair" by 24% (n = 81), and "Poor" by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%).
  
  
  CONCLUSIONS
  This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be "excellent" or "good" than would be expected, with 30% of BCT survivors reporting "fair" or "poor" cosmesis. Patient reported incidence of chronic pain, as well as cognitive and sexual changes, also appears higher than expected.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA. hill@uphs.upenn.edu
authors.forename: Christine E
authors.initials: CE
authors.lastname: Hill-Kayser
authors.forename: Carolyn
authors.initials: C
authors.lastname: Vachani
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Hampshire
authors.forename: Gloria A
authors.initials: GA
authors.lastname: Di Lullo
authors.forename: James M
authors.initials: JM
authors.lastname: Metz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000532:radiotherapy / Q000601:surgery; D059350:Chronic Pain; D003131:Combined Modality Therapy / Q000379:methods; D003219:Confidentiality; D004954:Esthetics; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications* / Q000473:pathology; D011855:Radiodermatitis / Q000473:pathology; D011878:Radiotherapy / Q000706:statistics & numerical data; D019529:Sexuality; D011795:Surveys and Questionnaires; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult