Wei, Xia; Oxley, Samuel; Sideris, Michail; Kalra, Ashwin; Brentnall, Adam; Sun, Li; Yang, Li; ... Manchanda, Ranjit; + view all Wei, Xia; Oxley, Samuel; Sideris, Michail; Kalra, Ashwin; Brentnall, Adam; Sun, Li; Yang, Li; Legood, Rosa; Manchanda, Ranjit; - view fewer (2023) Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology S0002-9378(23)00240. 10.1016/j.ajog.2023.03.045. (In press).

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Abstract

OBJECTIVE: To assess the impact of risk-reducing surgery (RRS) for breast cancer (BC) and ovarian cancer (OC) prevention on quality-of-life (QoL). We consider risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), and risk-reducing early-salpingectomy and delayed-oophorectomy (RRESDO). DATA SOURCES: We followed a prospective protocol (PROSPERO: CRD42022319782) and searched MEDLINE, EMBASE, PubMed, and Cochrane Library from inception to February 2023. STUDY ELIGIBILITY CRITERIA: We followed a PICOS framework. The population included women at increased risk of BC or OC. We focused on studies reporting QoL outcomes (health-related QoL (HRQoL), sexual function, menopause symptoms, body image, cancer-related distress or worry, anxiety or depression) after RRS, including RRM for BC and RRSO or RRESDO for OC. STUDY APPRAISAL AND SYNTHESIS METHODS: We used the Methodological Index for Non-Randomized Studies (MINORS) for study appraisal. Qualitative synthesis and fixed-effects meta-analysis was performed. RESULTS: Thirty-four studies were included (RRM:16 studies, RRSO: 19 studies, RRESDO: 2 studies). HRQoL was unchanged or improved in 13/15 studies post-RRM (N=986) and 10/16 studies post-RRSO (N=1617), despite short-term deficits (N=96 post-RRM and N=459 post-RRSO). Sexual function (using Sexual Activity Questionnaire) was affected in 13/16 studies (N=1400) post-RRSO, in terms of decreased sexual pleasure (-1.21[-1.53,-0.89]; N=3070) and increased sexual discomfort (1.12[0.93,1.31]; N=1400). Hormone replacement therapy after pre-menopausal RRSO was associated with an increase (1.16[0.17,2.15]; N=291) in sexual pleasure and a decrease (-1.20[-1.75,-0.65]; N=157) in sexual discomfort. Sexual function was affected in 4/13 studies (N=147) post-RRM, but stable in 9/13 studies (N=799). Body image was unaffected in 7/13 studies (N=605) post-RRM, whereas 6/13 studies (N=391) reported worsening. Increased menopause symptoms were reported in 12/13 studies (N=1759) post-RRSO with a reduction (-1.96[-2.81,-1.10]; N=1745) in Functional Assessment of Cancer Therapy-Endocrine Subscale. Cancer-related distress was unchanged or decreased in 5/5 studies post-RRM (N=365) and 8/10 studies post-RRSO (N=1223). RRESDO (2 studies, N=413) had better sexual function and menopause-specific QoL. CONCLUSION: RRS may be associated with QoL outcomes. RRM and RRSO reduce cancer-related distress, and do not affect HRQoL. Women and clinicians should be aware of body image problems post-RRM, together-with sexual dysfunction and menopause symptoms post-RRSO. RRESDO may be a promising alternative to mitigate QoL-related risks of RRSO.

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