In a substudy of the ECOG-ACRIN E4112 cohort trial reported in JAMA Network Open, Fazeli et al found that approximately half of women with ductal carcinoma in situ (DCIS) undergoing magnetic resonance imaging (MRI) for pretreatment planning experienced fear or anxiety before and during the procedure.
As stated by the investigators, “The use of MRI in pretreatment planning of DCIS remains controversial. Understanding changes in short-term health-related quality of life associated with breast MRI would allow for a more complete comparative effectiveness assessment.”
Study Details
The study included 355 women recently diagnosed with unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration. Participants underwent bilateral breast MRI within 30 days of study registration and before surgery. The primary outcome was patient-reported testing burden of breast MRI assessed by the Testing Morbidities Index (TMI) summated scale score; the TMI is a 7-item questionnaire evaluating temporary changes in quality of life associated with imaging before, during, and after the procedure (0–100 scale; 0 = worst possible). Patients were to complete questionnaires at two timepoints: after MRI and before surgery.
In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.— Fazeli et al
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Key Findings
Of 355 women who met eligibility criteria, 244 (69%) completed both questionnaires and were included in the analysis.
Among the 244 women, 142 (58%) experienced at least some fear or anxiety before the examination (some = 46%, a lot = 9%, extreme = 3%), and 120 (49%) experienced fear or anxiety during the examination (some = 43%, a lot = 5%, extreme = 1%).
A total of 79 women (32%) reported at least some pain or discomfort before the examination (some = 30%, a lot = 2%, extreme = 0.4%), and 156 (64%) experienced pain or discomfort during the examination (some = 54%, a lot = 8%, extreme = 2%).
After the examination, 210 women (86%) reported no residual mental discomfort and 212 (87%) reported no physical discomfort.
TMI summated scale scores were 82.0 (95% confidence interval [CI] = 79.9–84.0) before examination and 82.7 (95% CI = 80.9–84.4) during examination, compared with 94.8 (95% CI = 93.3–96.3) after examination (P < .001 for both comparisons).
In multivariate analysis, greater test-related burden indicated by lower TMI summated scale score was significantly associated with higher levels of cancer worry (regression coefficient = −2.75, standard error = 0.94, P = .004).
The investigators concluded, “In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.”
Ruth C. Carlos, MD, MS, of the Department of Radiology, University of Michigan, Ann Arbor, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
