An Analysis of Health-Related Quality of Life and Cost with Breast-Conserving Surgery versus Modified Radical Mastectnomy for Early-Stages Breast Cancer Patients

Breast cancer is the second most prevalent cancer of woman in Taiwan and its mortality rate ranks the fourth among the ten leading causes of death in Taiwan. There exist many studies focused on breast cancer epidemiology, pathology, diagnosis, and treatment in Taiwan. However, patients’ feelings, quality of life, and cost after intervention of treatments, are also meaningful subjects that deserve study.
The purposes of this study were to find out influence factors of patient underwent breast-conservation surgery (BCS) or modified radical mastectomy (MRM). Also to investigate the health-related quality of life (HRQoL) and cost of care for patients underwent BCS and MRM. . Study sample were 160 patients with early stages breast cancer undergoing treatment in one medical center in Taipei from July 1 1999 to December 31 2002. Data were collected by interviewing patients with telephone. The questionnaire used contains the Taiwan (Chinese) versions of EORTC QLQ-C30, EORTC QLQ-BR23 modules, basic demographic questions and out of pocket expenditures. Additional demographic data, the status of treatment, and insurance claim data of medical expenditures of these patients were provided by the study hospital.
The major results of this study are as follow:
1. Of the 160 patients interviewed, about 20% received BCS, and 80% received MRM. Almost half of the patients were undergoing Tamoxifen therapy.
2. The average medical expenditures in the period of hospitalization was NT$ 41,549, surgery cost ranks the highest, and anesthetic cost ranks the second. The average medical expenditures for follow-up visit was NT$ 87,739. Drug cost accounted for the highest proportions of outpatient care.
3. In terms of the score of EORTC QLQ-C30 and EORTC QLQ-BR23, “insomnia”, “fatigue”, “arm symptoms”, and “systemic therapy side effects” were the most serious problems. The result of multiple regression analysis showed that age positively affects the scores of “Emotional functional”. Patients who received MRM had “body image” scores significantly lower than patients who received BCS. According to the results of logistic regression analysis, patients who received MRM had higher chance of being classified at high “emotional functional” scores than BCS patients (OR=4.509). Patients Received BCS had higher chance of being classified at high’ “Body image” scores than MRM patients’ (OR=3.268).
4. In multiple regression analysis, we find that patients received MRM whose hospitalization medical expenditures were higher than BCS. In ambulatory medical expenditures, age and clinical stages were negatively correlated. From the results of the logistic regression analysis, we find that patients who received MRM had higher chance of being classified at high hospitalization medical expenditures than BCS patients (OR=2.415). Patients received BCS had higher chance of being classified at high ambulatory expenditures than MRM patients’ (OR=3.831). Patients who were at clinical stage Ⅱ had a higher chance of being classified at high ambulatory expenditures than that of the clinical stage Ⅰ (OR=2.829).
Based on the results of this study, we find that the total medical expenditures for BCS were higher than that of MRM. But the HRQoL for BCS patients was also better than that for MRM patients. These results suggest that Breast-conservation surgery can be recommended to most of the early-stages breast cancer patients. We suggest that patients be included in the decision process when counseling with a surgeon, an oncology radiologist, and an oncologist.

Key words: early-stages breast cancer, breast-conservation surgery, modified radical mastectomy, cost analysis, health-related quality of life.