Quality of Life Among Patients With Ductal Carcinoma In Situ

TL;DR

This study found that race, insurance type, and number of surgeries affect mental and physical health outcomes in DCIS breast cancer patients over two years.

Contribution

The study identifies specific social and clinical factors linked to long-term quality of life in DCIS patients.

Findings

Minoritized race and multiple surgeries were linked to worse mental health over two years.

Nonprivate insurance was associated with declines in both mental and physical health.

Non-White women with multiple surgeries had a significant mental health decline.

Abstract

Are clinical or social determinants of health factors associated with health-related quality of life in the 2-year period following surgery for ductal carcinoma in situ (DCIS) breast cancer?

In this cohort study including 296 patients with DCIS, minoritized race (including American Indian or Alaska Native, Asian, Black, multiracial, and unknown or not reported) and receiving more than 1 surgery were associated with worsening long-term mental health, and nonprivate insurance was associated with worsening of both mental and physical health. Non-White women who received more than 1 surgery experienced a sustained decline in mental health substantially larger than the defined minimal important change.

Interventions aimed at improving mental health outcomes for at-risk DCIS patients are a crucial next step.

This cohort study and secondary analysis of a nonrandomized clinical trial examines health-related quality of life by race following surgery for ductal carcinoma in situ breast cancer.

Limited longitudinal data exist regarding health-related quality of life (HRQL) following surgery for ductal carcinoma in situ (DCIS) breast cancer.

To assess individual- and neighborhood-level factors associated with longitudinal trajectories of mental and physical HRQL among individuals with DCIS eligible for breast conservation surgery.

This cohort study was an ancillary to a prospective, nonrandomized clinical trial of women with DCIS breast cancer between March 2015 and April 2016 at 75 US institutions, community practices, and academic centers coordinated by the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group (E4112). Eligible participants were recently diagnosed with unilateral DCIS who were eligible for wide local excision (WLE) and had a diagnostic mammogram within 3 months of study registration. Patient-reported outcome (PRO) questionnaires were administered to participants at the time of registration, after surgeon consultation but presurgery, at the first postoperative visit, 12 months postsurgery, and 24 months postsurgery. Self-reported social determinants of health (SDOH) and clinical history and surgery received were also collected. Data were analyzed from June 2024 to November 2024.

PRO measures assessing patient knowledge of DCIS and perception of being informed; HRQL, measured using the 10-item Patient-Reported Outcomes Measurement Information System with mental and physical health subscales.

Among the 296 women, the median age at enrollment was 60 years (range, 34-87 years) (11 Asian [4%], 41 Black [14%], 229 White [77%]); 147 participants (50%) reported at least 1 family member with breast cancer. The majority of participants had non-Hispanic ethnicity (280 [95%]), had private insurance (227 [77%]), resided in areas of low-to-moderate deprivation (ADI median, 44 [range, 1-99]), and received a single WLE (185 [63%]). Participants exhibited good knowledge of DCIS (median, 80 [range, 20-100]) and a high perception of being informed (median, 10 [range, 3-10]). Being American Indian or Alaska Native, Asian, Black, multiracial, or not reporting race (χ2 = 6.8 [df, 2]; P = .03), having insurance other than private (χ2 = 14.3 [df, 2]; P < .001), and having more than 1 surgery (χ2 = 12.3 [df, 4]; P = .02) were associated with decreases in mental health at 24 months compared with baseline. Having private insurance and a low perception of being informed of one’s treatment were associated with increases in physical health at 2 years.

In this cohort study of women with DCIS, in the 24 months following diagnosis, nonprivate insurance, minoritized race, and number of surgeries received were associated with reduced mental HRQL. Nonprivate insurance was also associated with reduced physical HRQL.

ClinicalTrials.gov Identifier: NCT02352883

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