Patient-Reported Outcomes After Same-Day Mastectomy Among Older Breast Cancer Patients: Results From a Prospective Clinical Trial

TL;DR

Older breast cancer patients who had same-day mastectomy reported similar recovery quality as those who stayed in the hospital, suggesting it is a viable option for them.

Contribution

This study provides patient-reported outcomes on same-day mastectomy for older breast cancer patients, a perspective that is underreported in the literature.

Findings

No significant differences in recovery quality were found between same-day discharge and admitted patients.

Same-day discharge patients slightly favored feeling rested, good sleep, less pain, and fewer anxiety/depression symptoms.

The results suggest same-day mastectomy is a safe and viable option for older patients.

Abstract

The safety and value of same-day mastectomy are well-documented but the patient perspective is underreported, especially among older patients. This study aimed to investigate older patient-reported recovery quality after mastectomy; we hypothesized that patients who were discharged same day would report better recovery.

A prospective trial included frailty screening and prehabilitation for patients age ≥ 65 undergoing mastectomy for breast cancer. Primary endpoint, same-day discharge rate, was previously reported and was significantly higher than the year prior. Secondary endpoint was patient-reported postoperative recovery quality, per the Quality of Recovery-15 measure (QoR-15; 15 questions scored 1–10, 10 being best). Patients responded by phone 24–72 h postdischarge. One-tailed T-tests compared responses between same-day and admitted patients.

37/55 (67.3%) patients ≥ 65 who underwent unilateral/bilateral mastectomy for early-stage breast cancer responded. Mean age was 73.6 (standard deviation 7.6), most had invasive carcinoma (44, 80.0%), and mean 5-factor Modified Frailty Index (mFI-5) was 1.3 of 5 (standard deviation 0.9); nonresponders had similar characteristics. There were no significant differences in any QoR-15 item (all p > 0.05). In fact, most responses were very similar, different by only one-tenth of 1 point or identical. The following answers slightly (0.2 difference or more) numerically favored same-day discharge: feeling rested, having good sleep, less moderate pain, and freedom from feeling anxious or depressed. No items favored admission.

Although this trial was not powered for secondary analyses, it is clinically meaningful that older patients undergoing same-day mastectomy reported similar recovery quality as those admitted. Same-day mastectomy should be considered for older patients.

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