For the past four years, University of Colorado Cancer Center member Sarah Tevis, MD, has focused her research on the psychosocial outcomes of breast surgery for women with breast cancer — specifically comparing patient-reported outcomes three and six months after receiving a lumpectomy (surgery in which just the tumor and some of the surrounding cells are removed) and a mastectomy (surgery to remove the entire breast).
Armed with a new five-year Clinician Scientist Development Grant from the American Cancer Society (ACS), Tevis plans to look at results from an even longer time period after surgery — one year — and to start building an online decision aid that will help women newly diagnosed with breast cancer decide which type of surgery is likely to result in a better quality of life.
“We’ve already published our shorter-term outcomes comparing quality of life after lumpectomy versus mastectomy,” says Tevis, assistant professor of surgical oncology at the CU Department of Surgery. “This grant will allow us to look at longer-term outcomes after surgery and see what the differences are in quality of life, as well as other factors that predict quality of life besides surgery: patient factors, disease factors, other treatments they receive. We’re going to ask patients about what their quality of life was like throughout treatment so we can better understand what’s causing the changes in quality of life.”
Closer look at physical wellbeing
In the six-month study, patients who underwent lumpectomy reported higher satisfaction with their breasts, better psychosocial wellbeing, and better sexual health scores than the mastectomy patients. Interestingly, Tevis says, lumpectomy patients six months after surgery reported lower physical wellbeing scores than the mastectomy patients.
“We want to do a deeper dive into that, and that’s one of the reasons we’re doing this qualitative study with patients, asking them about their experience,” Tevis says. “We think it could be due to a few things. One is that after lumpectomy, patients are more likely to get radiation. So their recovery after surgery might take longer because of the radiation period. It also could be the way in which we set expectations. We say, ‘Mastectomy is a big operation, you’re going to have drains, you’re going to have pain; lumpectomy is a smaller operation, you might not even need pain medicine. So part of it might be expectation setting.”
Shared decision making
Expectation levels and recovery after surgery are among the elements Tevis is considering including in her online decision aid. She envisions the tool as something a doctor and a patient would complete together, resulting in a one-page printed summary a patient could bring home after their visit to consult as they decide which surgery is best for their circumstances.
“Patients can fill out the survey to determine what their quality of life is before treatment, and then whatever other information we find is pertinent,” Tevis says. “It may be their age, or how big their cancer is, or if they’re going to need radiation. It will allow us to give them a predicted quality of life, based on the type of surgery they might have. It will be another piece of the puzzle besides the cancer outcomes we talk to patients about, including survival rates and risk of recurrence.”
The results will be in four domains, Tevis says: satisfaction with breasts, psychosocial wellbeing, physical wellbeing, and sexual health. She also plans to talk with patients about how they prefer to receive the information.
“We’re going to ask them, ‘If we're trying to convey information to you about your physical wellbeing after surgery, how does that best make sense? Do you want us to tell you what the likelihood is you'll be back to your original physical wellbeing after surgery? Do you want us to convey it numerically? How should we show you that type of information?,’ she says. “That’s going to be a really important step in getting patients’ perspectives. We’re not used to showing them this kind of data.”
Tevis says she was honored to receive the ACS award, which is designed to support junior faculty members in becoming independent investigators as clinician scientists.
“It really gives me time to grow my research program,” she says. “It gives me some salary support, so I can have protected time to really focus on this work, and it also gives me resources to build a team to get the project accomplished.”