Patient-reported Outcomes After Routine Treatment of In Situ/Atypical Lesions: The PORTAL Study.

Abstract

Guideline concordant care (GCC) for ductal carcinoma in situ (DCIS) includes some combination of surgery, radiation, and/or endocrine treatment. Active monitoring (AM) is a common approach for high-risk breast histologies (e.g., atypical ductal hyperplasia [ADH] lobular intraepithelial neoplasias [LIN]) and has been proposed as an alternative to GCC for some low-risk DCIS. We compared patient-reported outcomes in women with DCIS who received GCC with those with other high-risk breast histologies in an active monitoring-proxy group (AM-P). Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group. A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25-0.49) and clinically significant pain (0.43, 95% CI 0.28-0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups. Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.