title: Patient-reported outcomes in ductal carcinoma in situ: A systematic review.
abstract: Ductal carcinoma in situ (DCIS) is a pre-invasive breast cancer with excellent prognosis but with potential adverse impacts of diagnosis and treatment on quality of life and other patient-reported outcomes (PROs). We undertook a systematic review to synthesise current evidence about PROs following diagnosis and treatment for DCIS. We searched five electronic databases (from database inception to November 2015), cross-referenced and contacted experts to identify studies that reported PROs after DCIS treatment. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Of 2130 papers screened, 23 were eligible, reporting 17 studies. Short- and long-term PRO evidence about differences between DCIS treatment options was lacking. Evidence pooled across treatments indicated core aspects of quality of life (physical, role, social, emotional function, pain, fatigue) and psychological distress (anxiety, depression) were impacted significantly initially, with most aspects returning to population norms by 6-12 months, and all by 2 years post-operatively. Fears of recurrence and dying from breast cancer were exaggerated, occurred early and persisted for many years. Sexuality and body image impacts were generally low and resolved within 1-3 months after surgery. A minority of women experienced considerable impact, including depression and sexual issues associated with body image problems. Well-powered PRO studies are required to track recovery trajectories and long-term impacts of the range of contemporary and emerging local and systemic treatments for DCIS. PRO data would enable care providers to prepare patients for short-term sequelae and enable patients who have treatment options to exercise preferences in choosing among them.
authors.affiliation: School of Psychology, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia. Electronic address: madeleine.king@sydney.edu.au.
authors.forename: Madeleine T
authors.initials: MT
authors.lastname: King
authors.affiliation: Patient Reported & Clinical Outcomes Research Group, University of Bristol, UK.
authors.forename: Zoë E
authors.initials: ZE
authors.lastname: Winters
authors.affiliation: University of Calgary, Alberta, Canada.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Spillane
authors.affiliation: Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Boon H
authors.initials: BH
authors.lastname: Chua
authors.affiliation: School of Surgery, University of Western Australia, Perth, WA, Australia.
authors.forename: Christobel
authors.initials: C
authors.lastname: Saunders
authors.affiliation: Department of Radiation Oncology, Radiotherapiegroep, Arnhem, The Netherlands.
authors.forename: A Helen
authors.initials: AH
authors.lastname: Westenberg
authors.affiliation: Royal Melbourne and Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
authors.affiliation: WA Cancer Physiotherapy Centre, Perth, WA, Australia.
authors.forename: Petrina
authors.initials: P
authors.lastname: Burnett
authors.affiliation: Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: School of Psychology, University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rutherford
mesh_terms: D001007:Anxiety / Q000209:etiology; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000523:psychology* / Q000628:therapy; D005221:Fatigue / Q000209:etiology; D005260:Female; D006304:Health Status; D006801:Humans; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D013315:Stress, Psychological / Q000209:etiology
keywords: Anxiety; Body image; Carcinoma, intraductal, noninfiltrating; Depression; Pain; Patient outcome assessment; Quality of life; Sexuality; Stress, psychological