Post-treatment patient satisfaction in early-stage breast cancer: comparison of cryoablation versus breast conservation therapy using BREAST-Q

Background: De-escalation of local treatments for breast cancer is progressing, with breast-conserving therapy (BCT) representing approximately 60% of all breast cancer cases in Japan. Nonsurgical therapies have emerged as a novel treatment option. Assessing the health-related quality of life (HRQOL) and patient satisfaction following breast cancer surgery holds significant clinical importance. This study aimed to evaluate satisfaction after cryoablation or BCT in patients with early-stage breast cancer. Methods: Women with stage 0 or 1 breast cancer who underwent cryoablation or BCT between April 1 and June 30, 2022 were included. Exclusion criteria encompassed recurrence, axillary dissection, tumor diameter <15 mm, bilateral breast cancer, or pre-procedure irradiation. This study used the BREAST-Q questionnaire to assess patient HRQOL and satisfaction. The BREAST-Q questionnaire was administered postoperatively, and scores were compared using propensity score matching to adjust for baseline differences between the two groups. Results: Post-operative satisfaction was compared between cryoablation and BCT groups in patients with early-stage breast cancer. Between April 1 and June 30, 2022, a total of 147 Asian female breast cancer patients underwent cryoablation (n=42) or BCT (n=105). Among the 112 patients with stage 0 or 1 disease, 36 were excluded, and the remaining 76 (35 from the cryoablation group and 41 from the BCT group) were included in the analysis. There were no significant differences in observation period, age, or body mass index (BMI) between the groups. All patients received post-operative radiation therapy. While about a quarter of BCT patients received post-operative chemotherapy, none in the cryoablation group did (26.8% vs. 0%, P=0.003). Patients who underwent cryoablation compared to BCT reported significantly higher satisfaction (71.0 +/- 18.6 vs. 56.3 +/- 16.5) in the primary outcome, with a mean follow-up of 4.2 and 4.0 years, respectively. This trend was consistent across all the other measures. Adjustment for patient characteristics showed higher satisfaction in the cryoablation group, including age, BMI, and follow-up period between surgery and the survey. Conclusions: Cryoablation resulted in greater HRQOL and patient satisfaction than BCT for early-stage breast cancer. Our findings offer valuable insights underpinning treatment options for patients with earlystage, low-grade breast cancer.