Abstract P2-01-02: Patient’s Preference for Shared Decision Making-Based Distant Metastasis Surveillance and Its Effect on the Quality of Life: A Prospective Pragmatic Trial

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Abstract Background: Major guidelines recommend against the routine use of surveillance imaging tests to detect distant metastasis in patients with early-stage breast cancer, as such tests in asymptomatic patients do not significantly impact survival rates and often lead to unnecessary follow-up procedures and increased patient anxiety. Despite these guidelines, a significant number of imaging studies are still performed, highlighting a gap between recommendations and clinical practice. This study aims to assess the patient’s preference for the use of surveillance imaging tests for distant metastasis detection and to evaluate degree of quality of life associated with different surveillance strategies in early breast cancer patients. Methods: A prospective pragmatic clinical trial was conducted from July 2021 to December 2023 at three breast cancer centers in Seoul, South Korea. The study initially aimed to enroll 264 patients, but enrollment was stopped after enrolling 238 patients. Patients with early-stage breast cancer who had completed treatment within the past two years were enrolled and randomized into a shared-decision making (SDM) group or a control care group. Patients in SDM group were educated with videos and leaflets about the lack of clinical evidence for performing imaging tests to detect asymptomatic distant metastasis. The control care group underwent surveillance imaging studies of institutional practice during the follow-up period, while the SDM group was followed according to their preference for distant metastasis surveillance. Primary endpoints were quality of life (QoL), anxiety, and depression at enrollment, and at 6-month, 1-year, and 2-year visits. The Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Hospital Anxiety and Depression Scale (HADS) were used for assessments. Results: A total of 787 questionnaires were collected from 238 patients. The FACT-B total score of the control group was significantly higher at enrollment (107.6 ± 21.1 vs. 102.0 ± 20.8, p=0.040), but converged over time with no significant differences at subsequent visits. The overall anxiety score (6.1 ± 3.3 vs. 5.5 ± 3.7, p=0.017) was significantly higher in the SDM group, but the difference was insignificant when compared at each visit. There were no significant differences in depression score at any time point. In the SDM group, 117 patients were asked for their preferences for distant metastasis surveillance and 33 patients (29.1%) preferred not to receive unnecessary imaging. At enrollment, this guideline-based surveillance group had significantly higher FACT-B total scores compared to those who preferred imaging for distant metastasis (113.9 ± 15.6 vs. 97.4 ± 20.5, p<0.001). The difference remained significant at 6-month visit (107.7 ± 15.4 vs. 98.6 ± 20.8, p=0.026), but not at 1-year or 2- year. Similarly, both anxiety and depression scores were significantly lower in those who preferred guideline-based surveillance at enrollment, but not at subsequent time points. Conclusion: This pragmatic trial demonstrates that with adequate patient education and shared decision making, guideline-based surveillance imaging does not negatively impact patients’ quality of life, anxiety, or depression level. These findings support an evidence-based strategy for the surveillance of patients with early-stage breast cancer. Citation Format: Ji-Jung Jung, Jonghan Yu, Jong-Ho Cheun, Ki-Tae Hwang, Jai-Min Ryu, Se-Kyung Lee, Byung-Joo Chae, Jeong-Eon Lee, Seok-Won Kim, Seok-Jin Nam, Hong-Kyu Kim, Han-Byoel Lee, Wonshik Han, Hyeong-gon Moon. Patient’s Preference for Shared Decision Making-Based Distant Metastasis Surveillance and Its Effect on the Quality of Life: A Prospective Pragmatic Trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-01-02.

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