The Use of Breast Cup Immobilization in Radiation Therapy and Patient-Reported Outcomes on Cosmesis and Pain

Abstract

Purpose

Breast cosmesis and breast pain are among the most reported outcomes in patients undergoing adjuvant breast irradiation. The degree to which such adverse reactions occur can be variable based on different patient-specific characteristics. It has been found that women with a larger body habitus, and larger breasts, tend to have an increased chance of experiencing worse toxicity from treatment. As such, attempts to improve cosmetic and pain outcomes have been a highly explored topic. One such technique, that is studied here, is to explore whether the use of a breast cup during treatment leads to worse breast pain and cosmetic outcomes when compared with those treated without a breast cup. This proves to be an important topic because it is believed that the use of a breast cup would provide a significant dosimetric advantage (ie, breast coverage and organ at risk dosing) during treatment. We now explore this treatment option through the scope of a retrospective analysis of patient-reported outcomes experienced during and after completing postoperative radiation therapy to the breast.

Methods and Materials

A total of 645 patients undergoing adjuvant breast irradiation were evaluated from 2011 to 2019. Of the 645 patients, 79 were treated using a breast cup. The mean heart dose was analyzed and compared between the 2 treatment groups. Additionally, patient-reported outcomes among the entire cohort were collected via survey documentation forms during treatment, at 1 month after the completion of treatment, and at 1 year after the completion of treatment. These results were collected using the Michigan Radiation Oncology Quality Consortium database because each patient was consented to enroll in the Michigan Radiation Oncology Quality Consortium prior to starting treatment. The outcomes of skin changes, lymphedema, and breast pain among the 2 treatment groups were then compared for statistically significant differences via a logistic regression analysis.

Results

Of the 79 patients treated with a breast cup, grade 2 pruritus of the treated breast along with grade 1 alteration in skin texture was reported in 49.4%, 35.4%, and 22.8% while on treatment, at 1 month after the completion of treatment, and at 1 year after treatment, respectively; P-values were nonsignificant at all timepoints when data compared with non-cup-treated patients. With regard to lymphedema, 59.5%, 40.5%, and 10.1% of breast cup patients at the prespecified timepoints reported this sequela; all P-values were nonsignificant except for the 1-month mark (P-value .03). Lastly, breast pain was noted in 36.7%, 15.2%, and 11.4% of breast cup-treated patients while on treatment, at 1 month after the completion of treatment, and at 1 year after treatment, respectively; again, P-values for data analysis at each timepoint were nonsignificant. Other than the patient-reported outcome of lymphedema 1 month after the completion of treatment, no statistical significance was seen in comparing side effects between the 2 treatment arms.

Conclusions

From our patients’ perspective, the use of a breast cup during radiation therapy did not negatively impact breast cosmesis or pain when compared with patients treated without a cup. Furthermore, breast cup use was also found to produce a lower overall mean heart dose in patients with left-sided breast cancer.