569 Background: Patient-reported outcomes (PROs) of cosmesis after breast-conserving therapy (BCT) are increasingly emphasized as meaningful treatment endpoints but little is known about the relationship between objective measures, mood, and PROs following radiation (XRT). We hypothesized that pre-XRT depression, assessed by Inventory of Depressive Symptomatology Self-Report (IDS-SR), would influence PROs of breast cosmesis 1-year post-XRT independent of objective measures of breast asymmetry. Methods: 98 women were enrolled on two prospective longitudinal studies of breast cosmesis. Percentage breast retraction assessment (pBRA) was used as an objective measure of breast asymmetry pre- and 1 year post-XRT. At the same time points, pBRA was measured and compared with two different PRO ratings of cosmetic outcome (0-10 scale): 1) happiness with cosmesis and 2) perceived differences in treated vs. untreated breast. We performed univariate and multivariate analysis to evaluate the relationship between PROs, pBRA, IDS-SR scores, clinical, tumor, and treatment characteristics. Results: Among subjects, 50% were African American. Mean age was 56.45 years. At 1 year, 65.3% of patients were happy with their cosmetic outcome (Score > 8) although 59.5% noted moderate to severe differences in the treated vs. untreated breast (Score < 6). Mean pBRA increased from 7.20 (SD 3.88) pre-XRT to 9.69 (SD 6.22) confirming more breast asymmetry 1-year post-XRT. Prior to XRT, 23% of patients had moderate-to-severe depression (IDS-SR scores > 26). In multivariate analyses, 1 year PROs of happiness with cosmetic outcome did not correlate with pBRA (p = 0.3) but were strongly correlated with pre and post-XRT depression (all p < 0.05). Patients were more likely to perceive differences in breast texture or asymmetry (i.e. lower PRO ratings of asymmetry) if they had higher pBRA measurements at 1 year (all p = 0.004). Neither pre- nor post- XRT depression were associated with specific PRO ratings of breast asymmetry in multivariate analysis. Conclusions: Our study suggests that PROs may not always reflect the effects of cancer treatment. For patients treated with BCT, baseline depression strongly influenced patient reported happiness with overall cosmetic outcome 1 year post-XRT. Perceived differences in the treated vs. untreated breast correlated with objective measures of breast asymmetry. Our data suggests that this PRO may be more indicative of treatment-related toxicities than patient ratings of overall satisfaction and happiness with cosmetic outcome. Clinical trial information: NCT03167359 .
Are vasomotor symptoms associated with sleep characteristics among symptomatic midlife women? Comparisons of self-report and objective measures