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Shrivastava R, Gupta A, Bharath S, Yadav SK, Agarwal P, Sharma D, Shekhar S. Unveiling perceptions regarding post mastectomy breast reconstruction: A questionnaire-based survey of patients from central India. World J Surg 2024. [PMID: 39019650 DOI: 10.1002/wjs.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/07/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Post mastectomy breast reconstruction uptake remains low in the developing countries. We examined patient perspectives about it in a cohort of Indian breast cancer patients. METHODS This prospective study was conducted at a tertiary care center in central India. All post mastectomy patients for breast cancer were interviewed via a survey questionnaire to assess their perspective regarding post mastectomy breast reconstruction. RESULTS None of the 192 patients underwent immediate or delayed reconstruction by the end of 24 months follow-up. Age, education level, occupation and marital status did not affect the uptake of post mastectomy breast reconstruction. The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery and the belief that it was not important (80% for each). System related factors such as additional cost of surgery and additional length of stay were reported to be important by 55% and 65% patients respectively. CONCLUSION Our survey of 192 post mastectomy breast cancer patients showed that none opted for post mastectomy reconstruction, suggesting significant barriers to it. Understanding and addressing these barriers are crucial to ensuring comprehensive care for these breast cancer patients.
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Affiliation(s)
| | - Ashish Gupta
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | - S Bharath
- Department of Endocrine Surgery, KGMU, Lucknow, India
| | | | - Pawan Agarwal
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | | | - Saket Shekhar
- Department of Biostatistics, Rama Medical College, Kanpur, India
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2
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Paynter J, Qin KR, Brennan J, Hunter-Smith DJ, Rozen WM. The provision of general surgery in rural Australia: a narrative review. Med J Aust 2024; 220:258-263. [PMID: 38357826 DOI: 10.5694/mja2.52232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
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Affiliation(s)
- Jessica Paynter
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Kirby R Qin
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
| | - Janelle Brennan
- Monash Rural Health - Bendigo, Monash University, Bendigo, VIC
- Bendigo Health, Bendigo, VIC
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3
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Tian Y, Birks S, Kemp S, Lee JC, Weymouth M, Serpell J, Walker M. Patterns of breast reconstruction and the influence of a surgical multidisciplinary clinic. ANZ J Surg 2024; 94:163-168. [PMID: 38071497 DOI: 10.1111/ans.18816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision. METHODS A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5-year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared. RESULTS Over the 10-year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups. CONCLUSION The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease.
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Affiliation(s)
- Yuan Tian
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Birks
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Kemp
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - James C Lee
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
| | - Michael Weymouth
- Plastic Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Plastic and Reconstructive Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Melanie Walker
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
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Gunness P, Hamilton S, Capstick R, Masters J, Toma R. The development of a rural breast reconstruction service: patient reported outcomes and benefits. ANZ J Surg 2023; 93:1935-1937. [PMID: 36944602 DOI: 10.1111/ans.18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. RESULT Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. CONCLUSION Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.
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Affiliation(s)
- Preeya Gunness
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Sam Hamilton
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Capstick
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - John Masters
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Toma
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
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5
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Lai HW, Lin J, Sae-Lim C, Lin YJ, Chen DR, Lai YC, Lin SL, Chen ST. Oncoplastic and reconstructive breast surgeon performance and impact on breast reconstructions: Clinical outcomes, learning curve, and patients' satisfaction. Surg Oncol 2023; 47:101920. [PMID: 36871539 DOI: 10.1016/j.suronc.2023.101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Compared to mastectomy alone, the addition of breast reconstruction could improve quality of life and it is usually performed by two-team approach, which consisted of both breast surgeons and plastic surgeons. This study aims to illustrate the positive impacts of the dual-trained oncoplastic reconstructive breast surgeon (ORBS) and reveal the factors influencing reconstruction rates. METHODS This retrospective study enrolled 542 breast cancer patients who undergone mastectomy with reconstruction performed by a particular ORBS between January 2011 and December 2021 at a single institution. Clinical and oncological outcomes, impact of case accumulation on performance and patient-reported aesthetic satisfactions were analyzed and reported. Furthermore, in this study 1851 breast cancer patients treated with mastectomy combined with or without breast reconstructions, which included 542 performed by ORBS, were reviewed to identify factors affecting breast reconstructions. RESULTS Among the 524 breast reconstructions performed by the ORBS, 73.6% were gel implant reconstructions, 2.7% were tissue expanders, 19.5% were transverse rectus abdominal myocutaneous (TRAM) flaps, 2.7% were latissimus dorsi (LD) flaps, 0.8% were omentum flaps, and 0.8% involved LD flaps and implants. There was no total flap loss in the 124 autologous reconstructions, and the implant loss rate was 1.2% (5/403). Patient-reported aesthetic evaluations showed that 95% of the patients were satisfied. As the ORBS's accumulated case experiences, the implant loss rate decreased, and the overall satisfaction rate increased. According to the cumulative sum plot learning curve analysis, it took 58 procedures for the ORBS to shorten the operative time. In multivariate analysis, younger age, MRI, nipple sparing mastectomy, ORBS, and high-volume surgeon were factors related to breast reconstruction. CONCLUSION The current study demonstrated that a breast surgeon after adequate training could become an ORBS and perform mastectomies with various types of breast reconstruction with acceptable clinical and oncological outcomes for breast cancer patients. ORBSs could increase breast reconstruction rates, which remain low worldwide.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Division of Plastic and Reconstructive Surgery, Changhua Christian Hospital, Changhua, Taiwan; Minimally Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Joseph Lin
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Chayanee Sae-Lim
- Department of Surgery, Sirindhorn Hospital, Medical Service Department, Bangkok, Thailand.
| | - Ying-Jen Lin
- Tumor Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Yuan-Chieh Lai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Shou-Tung Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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6
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Dayaratna N, Nguyen CL, Spillane A, Mak C, Warrier SK, Dusseldorp JR. Trends and variations in post-mastectomy breast reconstruction rates in Australia over 10 years. ANZ J Surg 2023; 93:242-250. [PMID: 36651629 DOI: 10.1111/ans.18243] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Offering breast reconstruction (BR) at the time of mastectomy is standard of care in Australia with proven quality-of-life benefits. Previously BR rates in Australia have been low compared to similar countries. Accurate up-to-date information is needed to promote equity in access to BR and inform future planning of services. This study analysed recent trends and variations of BR uptake in Australia. METHOD Data from the BreastSurgANZ Quality Audit (BQA) were used to identify patients who underwent mastectomy with or without reconstruction for invasive or in situ breast carcinoma from 2010 to 2019. The association between BR uptake and the variables of jurisdiction (state or territory), age, hospital type and remoteness, and remoteness of patients' home addresses were analysed. RESULTS A total 41 880 women underwent mastectomy between 2010 to 2019. The national BR rate steadily increased from 12.8% in 2010 to 29% in 2019, with a 10-year national average of 21.3%. Statistically significant differences in BR uptake (P < 0.001) were found between states with higher rates in New South Wales and Victoria, with BR more likely in private hospitals and in younger women (P < 0.001), and less likely in remote areas (P < 0.001). CONCLUSION The Australian BR rate has increased over the 10-year period, but significant variation still exists between states. BR is lower in older women and those living in regional and remote areas. While the steady increase in BR uptake is encouraging, barriers that exist to equitable provision of reconstructive surgical services for all women living with breast cancer still need to be corrected.
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Affiliation(s)
- Nirmal Dayaratna
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, Sydney, New South Wales, Australia.,The Mater Hospital, Sydney, New South Wales, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Kumar Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph R Dusseldorp
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Concord Repatriation Hospital, Sydney, New South Wales, Australia
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7
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Sung N, Muthusamy A, Finn N, Stuart E, Fox J, Yeo B. Surgical management of breast cancer in Victoria: A state‐wide audit. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Nakjun Sung
- Melbourne Medical School University of Melbourne Melbourne Victoria Australia
| | - Arun Muthusamy
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
| | - Norah Finn
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Ella Stuart
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Jane Fox
- Department of Breast Services Monash Health Melbourne Victoria Australia
| | - Belinda Yeo
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
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8
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Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Immediate breast reconstruction uptake in older women with primary breast cancer: systematic review. Br J Surg 2022; 109:1063-1072. [PMID: 35909248 PMCID: PMC10364779 DOI: 10.1093/bjs/znac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Postmastectomy immediate breast reconstruction (PMIBR) may improve the quality of life of patients with breast cancer, of whom older women (aged 65 years or more) are a growing proportion. This study aimed to assess PMIBR in older women with regard to underlying impediments (if any). METHODS MEDLINE, Embase, and PubMed were searched by two independent researchers up to June 2022. Eligible studies compared PMIBR rates between younger and older women with invasive primary breast cancer. RESULTS A total of 10 studies (2012-2020) including 466 134 women were appraised, of whom two-thirds (313 298) were younger and one-third (152 836) older. Only 10.0 per cent of older women underwent PMIBR in contrast to 45.0 per cent of younger women. Two studies explored factors affecting uptake of PMIBR in older women; surgeon-associated (usual practice), patient-associated (socioeconomic status, ethnicity, and co-morbidities), and system-associated (insurance status and hospital location) factors were identified. CONCLUSION Uptake of PMIBR in older women is low with definable (and some correctable) barriers.
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Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria Joao Cardoso
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Breast Unit, Champalimaud Foundation and Nova Medical School Lisbon, Lisbon, Portugal
| | - Kwok Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Correspondence to: Ruth M. Parks, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK (e-mail: )
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Ho D, Chan E, Izwan S, Ng J, Teng R, Swindon D, Chang J. Uptake of breast reconstruction following mastectomy: a Gold Coast experience. ANZ J Surg 2022; 92:3011-3016. [PMID: 35426189 DOI: 10.1111/ans.17703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The breast reconstruction (BR) rate for women undergoing mastectomy for breast cancer management is 18% in Australia. The Australian Access to Breast Reconstruction Collaborative Group recommends that all women should have access to BR. This study presents BR uptake and outcomes from a breast surgical unit. METHODS A retrospective observational study identified women who had curative mastectomy for breast cancer between 1 January 2016 and 31 December 2021. Patient factors and surgical complications were compared between BR and no BR (NBR) patients. RESULTS Out of 929 women who had a curative mastectomy, 34% underwent reconstruction. Of this, 89% were immediate, and 11% were delayed. Reconstruction increased from 27% (2016) to 35% (2021). During this time, 588 women had a discussion for BR documented at their initial consultation, 58 after initial surgery and 283 were not documented. The rate of discussion prior to mastectomy increased from 38% to 74%. Women who had BR were more likely to be younger, premenopausal and less likely to be diabetic. Complications requiring return to theatre were higher in reconstructed women (13% vs. 7%). Overall, infected seroma, cellulitis requiring intravenous antibiotics and haematoma requiring drainage were comparable between both groups. CONCLUSION Our unit achieved a reconstruction rate of 34%, which is higher than national and international averages. Open discussion of reconstruction is crucial for women to make an informed decision. Further prospective studies exploring barriers to timely reconstruction will improve uptake of BR surgery and allow prioritization of BR services in Australia.
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Affiliation(s)
- Debbie Ho
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Erick Chan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Sara Izwan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Justin Ng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
| | - Roy Teng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Daisy Swindon
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Jennifer Chang
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
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10
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Dempsey K, Brennan ME, Spillane A. Inaugural roundtable on breast reconstruction practice in Australia: background, process and recommendations. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recommendations from the inaugural roundtable on breast reconstruction held on 9 October 2019 in Queensland, Australia, for improved decision-making and increased funding to support wider, timely access to breast reconstruction.
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11
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Soon PS, Karimi N, Wu VS, Girgis A. Having breast reconstruction post-mastectomy: barriers and facilitators reported by Vietnamese- versus English-speaking women with breast cancer. ETHNICITY & HEALTH 2022; 27:343-360. [PMID: 31746239 DOI: 10.1080/13557858.2019.1693513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: Little is known about the experience of women of culturally and linguistically diverse (CALD) backgrounds in relation to breast reconstruction following mastectomy as treatment for their breast cancer. The aim of this study was to explore the factors that influenced Vietnamese- and English-speaking women's decisions about breast reconstruction post-mastectomy for their breast cancer, in Australia.Design: The participants in this study comprised of Vietnamese-speaking women of Vietnamese heritage, and English-speaking women from mixed ethnicities (Vietnamese included). In this qualitative study, Vietnamese-speaking and English-speaking women who had breast cancer treated by mastectomy with or without breast reconstruction participated in in-depth interviews. Interviews were undertaken in the woman's chosen language (Vietnamese or English), audio-recorded, transcribed/translated and analysed using thematic analysis.Results: Fourteen Vietnamese-speaking and 13 English-speaking patients were recruited. Participants identified age, lack of information, concerns regarding surgical procedure, fears about complications and cancer recurrence as barriers to breast reconstruction. Many more Vietnamese-speaking participants identified lack of information about breast reconstruction as a barrier compared to English-speaking participants. Both groups described the ability to wear clothing of their choice, partner influence, and the need to feel 'normal' as facilitators to having breast reconstruction. Vietnamese-speaking participants in particular identified doctor recommendation of breast reconstruction as a major facilitator.Conclusion: Lack of information about reconstruction was a persistent theme, though it was identified by more Vietnamese women as a barrier to having breast reconstruction. The results reinforce the importance of doctors' recommendations in helping particularly the Vietnamese women make an informed decision about reconstruction following mastectomy as treatment for their breast cancer.
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Affiliation(s)
- Patsy S Soon
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Neda Karimi
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Verena S Wu
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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12
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Giunta S, Laidsaar-Powell R, Huang L, Hatcher N, Dhillon H, Muscat DM, Carroll S, McNeil C, Burke L, Howson P, Chan B, Juraskova I. Considering the type and timing of breast reconstruction after mastectomy: Qualitative insights into women's decision-making. Eur J Oncol Nurs 2021; 54:102024. [PMID: 34536790 DOI: 10.1016/j.ejon.2021.102024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/05/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The information women receive about the type and timing of breast reconstruction (BR) from healthcare providers is crucial to help them make an informed decision, and this is particularly important in complex cases and/or high-risk cases. This study sought to provide qualitative insights into Australian women's BR decision-making experiences. METHOD Twenty-nine women who had received a mastectomy and made decisions about BR, including the type (expander, implant and/or autologous) and timing (immediate, delayed or immediate-delayed), participated in semi-structured telephone interviews. Interviews were analysed thematically using the Framework method. RESULTS Seven themes were identified: 1) information provision and needs; 2) values and preferences; 3) pressure to decide; 4) feasibility (e.g. clinical and/or financial factors); 5) social influence and support; 6) multidisciplinary team and organisational structures; and 7) decision implementation and outcomes. Breast care nurse support, as well as collaboration and communication within multidisciplinary teams were perceived by women as facilitating the BR decision-making process. CONCLUSIONS The identified themes offer an in-depth explanation of how a sample of Australian women make BR decisions. The current findings highlight the often limited clinician-patient information-sharing and demonstrate the overarching influence of the multidisciplinary medical team and organisational structures on BR decision-making. Development of in-consult decision-aids and strategies to improve multidisciplinary care are discussed.
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Affiliation(s)
- Sarah Giunta
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Rebekah Laidsaar-Powell
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Lorna Huang
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Natasha Hatcher
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Haryana Dhillon
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Susan Carroll
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Catriona McNeil
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Lucinda Burke
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Pamela Howson
- Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Belinda Chan
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia.
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13
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Youl P, Philpot S, Moore J, Theile DE. Population-based picture of breast reconstruction in Queensland, Australia. ANZ J Surg 2021; 91:695-700. [PMID: 33724641 DOI: 10.1111/ans.16675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 40% of women with invasive breast cancer will undergo a mastectomy. Clinical practice guidelines recommend breast reconstruction (BR) options should be discussed with all women who are to undergo a mastectomy. We sought to examine rates of BR, BR methods over time and to identify factors associated with the likelihood of receiving BR in Queensland. METHODS This population-based study used linked data from the Queensland Oncology Repository for 12 364 women who underwent a mastectomy for invasive breast cancer from 2008 to 2017. Multivariate logistic regression was used to model predictors of immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR). RESULTS Overall, 2560 (20.7%) women had BR, with 9.8% having IBR and 10.9% having DBR. Factors associated with a reduced likelihood of IBR or DBR included older age (P < 0.001), living in a regional/rural area (P < 0.001) and having a mastectomy in a public versus private hospital (P < 0.001). Median time from mastectomy to DBR was 18.4 and 29.2 months for women attending a private versus public hospital, respectively (P < 0.001). Use of implant-based BR increased significantly with a corresponding decrease in autologous BR over time. CONCLUSIONS Significant disparities exist in rates of BR between public and private hospitals. Women living in regional and rural areas as well as those aged over 60 years continue to have lower rates of BR. Addressing the health system barriers and developing strategies to improve access to, and uptake of BR should be a priority.
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Affiliation(s)
- Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Julie Moore
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David E Theile
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
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14
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Ng EEI, Quah GS, Graham S, Kanesalingam K, Meybodi F, Hsu J, Elder EE, French J. Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction. ANZ J Surg 2021; 91:701-707. [PMID: 33634944 DOI: 10.1111/ans.16670] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implant-based reconstruction accounts for the majority of breast reconstructive procedures performed in Australia. More recently, immediate prepectoral implant reconstruction using the TiLOOP Bra Pocket has gained popularity. This study compares post-surgical complications and patient-reported quality of life outcomes between immediate prepectoral and dual plane implant reconstruction. METHODS A retrospective study of 80 consecutive patients who underwent nipple-sparing mastectomies and immediate implant reconstruction was conducted. Implants were either completely covered with TiLOOP Bra and/or TiLOOP Bra Pocket (pfm medical, Cologne, Germany) and secured in the prepectoral space (prepectoral group) or placed in the subpectoral plane with inferolateral mesh coverage (dual plane group). Data surrounding patient demographics, clinical details and post-surgical outcomes were compared. Patient-related quality of life outcomes were assessed with the Breast-Q questionnaire. RESULTS A total of 80 patients (109 breasts) operated on between June 2016 and December 2018 were included. The prepectoral and dual plane groups comprised of 40 patients each, including 50 and 59 operated breasts, respectively. Post-operative complications were comparable with 11 (22%) overall complications in the prepectoral group and eight (14%) in the dual plane group (P = 0.313). Implant loss was uncommon with four (8%) cases in the prepectoral group and five (8.5%) in the dual plane group (P = 0.929). Patient-reported quality of life outcomes were superior after prepectoral reconstruction with patients reporting a significantly higher score in the satisfaction with breasts domain (68.9 versus 57.5; P = 0.036). CONCLUSION Immediate prepectoral implant reconstruction with the TiLOOP Bra Pocket was associated with improved patient satisfaction and demonstrated no difference in early post-operative outcomes.
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Affiliation(s)
- E-Ern Ian Ng
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gaik Si Quah
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Susannah Graham
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kavitha Kanesalingam
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Farid Meybodi
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jeremy Hsu
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - Elisabeth E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
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15
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Karimi N, Descallar J, Girgis A, Soon PS. Breast reconstruction in South Western Sydney. ANZ J Surg 2020; 90:2340-2345. [PMID: 33021080 DOI: 10.1111/ans.16298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. METHODS The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. RESULTS The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). CONCLUSION This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.
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Affiliation(s)
- Neda Karimi
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy S Soon
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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16
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McCamley C, Mills C, Chow Y, Ross D, Fox J. Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital. ANZ J Surg 2020; 90:2334-2339. [PMID: 33021039 DOI: 10.1111/ans.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake. METHODS A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter. RESULTS Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR. CONCLUSIONS Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi-linguistic population.
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Affiliation(s)
- Chere McCamley
- Breast Service, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Christopher Mills
- Department of Surgery, West Gippsland Healthcare Group, Warragul, Victoria, Australia
| | - Yvonne Chow
- Department of Plastics and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
| | - David Ross
- Department of Plastics and Reconstructive Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Jane Fox
- Department of Breast Services, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine and Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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17
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Flitcroft K, Mathieu E, Turner L. Provision of breast reconstruction services in Australia: the case for change. ANZ J Surg 2020; 90:1546-1547. [PMID: 32924300 DOI: 10.1111/ans.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kathy Flitcroft
- Breast and Surgical Oncology at The Poche Centre, Sydney, New South Wales, Australia.,The University of Sydney, Northern Clinical School, Sydney, New South Wales, Australia
| | - Erin Mathieu
- The University of Sydney, School of Public Health, Sydney, New South Wales, Australia
| | - Louise Turner
- Reclaim Your Curves, Sydney, New South Wales, Australia
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18
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Heeg E, Jensen MB, Mureau MAM, Ejlertsen B, Tollenaar RAEM, Christiansen PM, Vrancken Peeters MTFD. Breast-contour preserving procedures for early-stage breast cancer: a population-based study of the trends, variation in practice and predictive characteristics in Denmark and the Netherlands. Breast Cancer Res Treat 2020; 182:709-718. [PMID: 32524354 PMCID: PMC7320958 DOI: 10.1007/s10549-020-05725-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Breast-contour preservation (BCP) is possible for most women treated for early-stage breast cancer. BCP can be defined as primary breast-conserving treatment (BCT), neoadjuvant chemotherapy (NAC) followed by BCT and immediate postmastectomy breast reconstruction (IBR). This study provides insight in current BCP strategies in Denmark and the Netherlands and aims to identify opportunities for improvement within both countries. METHODS A total of 92,881 patients with early-stage breast cancer who were operated in Denmark and the Netherlands between 2012 and 2017 were selected from the Danish Breast Cancer Group and the Dutch National Breast Cancer Audit databases. BCP procedures and predictive factors were analyzed within and between both countries. RESULTS BCP was achieved in 76.7% (n = 16,355) of the Danish and in 74.5% (n = 53,328) of the Dutch patients. While BCP rate did not change significantly over time in Denmark (p = 0.250), a significant increase in BCP rate from 69.5% in 2012 to 78.5% in 2017 (p < 0.001) was observed in the Netherlands. In both countries, variation in BCP rates between hospitals decreased over time. NAC followed by BCT and postmastectomy IBR was substantially more often used in the Netherlands compared to Denmark, specifically in patients younger than 50 years. CONCLUSIONS In more than 75% of all Danish and Dutch patients, surgically treated for early-stage breast cancer, the breast-contour was preserved. The different use of BCP strategies within Denmark and the Netherlands and the differences observed between hospitals in both countries emphasize the need for more (inter)national consensus on treatment modalities.
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Affiliation(s)
- E Heeg
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands. .,Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - M B Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B Ejlertsen
- Danish Breast Cancer Cooperative Group, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - R A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - P M Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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19
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Li Y, Sheene S, Locke M. Equity of access to post-mastectomy breast reconstruction at a regional plastic surgery centre. ANZ J Surg 2020; 90:1046-1051. [PMID: 31927785 DOI: 10.1111/ans.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/17/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Plastic and Reconstructive Surgery Department at the Counties Manukau District Health Board provides tertiary-level access to post-mastectomy breast reconstruction for all women in the northern region of New Zealand. Access to breast reconstruction is not always equitable. We aim to assess equity of access to breast reconstruction in this department. METHODS A retrospective review of all women referred to this service for immediate and delayed post-mastectomy breast reconstruction between January 2013 and June 2018 was performed. Demographic information and progression to reconstruction were assessed in comparison to expected population figures available from health statistics. RESULTS A total of 882 women were referred for breast reconstruction during this period. Significant discrepancies in ethnicity and geographical location were found between expected population proportions and the women referred for reconstruction. European women were more likely to be referred for, and receive, reconstruction. Māori women were proportionally represented in the cohort, whereas Asian and Pacific women were under-represented (P = 0.0016). Within the referral cohort, Māori and Asian women were less likely to proceed to reconstruction following first specialist assessment than European women (P = 0.0015 and 0.0193, respectively). Proportionally fewer referrals for reconstruction were received from health services further away from the treatment centre than were received from closer health services. CONCLUSION There is inequity in the rates of tertiary referral for breast reconstruction across ethnicities and geographical location in the northern region of New Zealand. Strategies to identify potential barriers such as access to transport may improve equity of access to breast reconstruction.
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Affiliation(s)
- Ye Li
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sandra Sheene
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Michelle Locke
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Auckland, New Zealand
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20
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Flitcroft K, Brennan M, Spillane A. On the frontiers of change: breast surgeons' views on demarcation between surgical sub-specialties in Australia. ANZ J Surg 2019; 90:317-324. [PMID: 31845437 DOI: 10.1111/ans.15580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/19/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The emergence of breast oncoplastic surgery provides women with more surgical options for improved aesthetics following breast-conserving surgery and for breast reconstruction (BR) following mastectomy. For some established breast and plastic surgeons, this development may be perceived as increasing competition for patients and raises the potential for demarcation issues between and within surgical sub-specialties. The objectives of the study were to document surgeons' views on demarcation between general/breast, oncoplastic/breast and plastic reconstructive breast surgeons in Australia, to examine the potential impact demarcation issues may have on informed patient choice and to recommend ways of reducing them. METHODS In-depth qualitative interviews were conducted with a convenience sample of 31 (22 oncoplastic and nine plastic reconstructive) surgeons who performed BR. RESULTS Descriptive analysis of the interviews revealed a range in the perceptions of the extent of demarcation. Six common themes were identified: oncoplastic techniques are unnecessary and potentially unsafe; reconstructive surgery should be left to 'the experts'; non-referral of patients for discussion of surgical options they do not offer; professional jealousy; workload capacity; and the old versus the new guard. Potential solutions suggested by the participants focused on improving relations between oncoplastic and plastic reconstructive surgeons and changes to breast surgical training. CONCLUSION While most surgeons were optimistic about the current divide diminishing with time, a more pro-active stance is required if patient-centred care is to be improved. Roundtable discussions with a broad range of stakeholders are planned to begin this process.
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Affiliation(s)
- Kathy Flitcroft
- Department of Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Meagan Brennan
- Department of Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Department of Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Breast Surgery, Mater Hospital, Sydney, New South Wales, Australia.,Department of Breast Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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21
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Heilat GB, Brennan ME, Kanesalingam K, Sriram N, Meybodi F, French J. Presentation, tumour and treatment features in immigrant women from Arabic-speaking countries treated for breast cancer in Australia. ANZ J Surg 2019; 90:325-331. [PMID: 31845467 DOI: 10.1111/ans.15596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/27/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Australia has a large population of immigrant women from Arabic-speaking countries. The aim of this study was to examine breast cancer tumour and surgical treatment features for women born in Arabic-speaking countries and compare them to women born in Australia and other countries. Another aim was to consider how this information can inform clinical care for this multicultural population. METHODS This is a retrospective audit of an institutional breast cancer database. Demographic, tumour and surgical treatment data were extracted for the Arab women and compared to Australian-born women (comparison 1) and to women born in all other countries (comparison 2); chi-squared analysis was performed to test for differences between groups. RESULTS A total of 2086 cases with country of birth information were identified, of whom 139 women (6.7%) were born in Arabic-speaking countries, 894 (42.8%) were born in Australia and 1053 (50.4%) were born in other countries (71 nations). Arab women tended to be younger (P = 0.013), more disadvantaged (P < 0.001), were more likely to have symptomatic rather than screen-detected breast cancer (P < 0.001), had a higher rate of high grade (P = 0.021), HER2-positive (P = 0.025) breast cancer compared to Australian-born women or others. There was no difference in tumour (pT) stage, rate of breast conservation versus mastectomy, re-excision and contralateral prophylactic mastectomy between groups. Australian-born women were more likely to undergo breast reconstruction after mastectomy (P < 0.001); reconstruction rate was >29% in all groups. CONCLUSION Women born in Arabic-speaking countries were younger, more disadvantaged and showed more aggressive tumour features. This has implications for supportive care during treatment and survivorship.
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Affiliation(s)
- Ghaith B Heilat
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Meagan E Brennan
- Northern and Western Clinical Schools, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavitha Kanesalingam
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nina Sriram
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Farid Meybodi
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
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22
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Flitcroft K, Brennan M, Salindera S, Spillane A. Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia. Support Care Cancer 2019; 28:2843-2856. [PMID: 31729569 DOI: 10.1007/s00520-019-05130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients' informed discussion of BR options and to improve access to BR for women living in underserved locations. METHODS Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas. RESULTS Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers. CONCLUSIONS Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK's system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.
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Affiliation(s)
- Kathy Flitcroft
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia. .,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Meagan Brennan
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.,Westmead Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Shehnarz Salindera
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Westmead Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Andrew Spillane
- Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia.,Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.,The Mater Hospital, North Sydney, NSW, 2060, Australia.,Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
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23
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Multicentre prospective observational study evaluating recommendations for mastectomy by multidisciplinary teams. Br J Surg 2019; 107:227-237. [PMID: 31691270 DOI: 10.1002/bjs.11383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision-making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in mastectomy rates. METHODS Consecutive patients undergoing mastectomy between 1 June 2015 and 29 February 2016 at participating units across the UK were recruited. Details of neoadjuvant systemic treatment (NST), operative and oncological data, and rationale for recommending mastectomy by MDTs were collected. RESULTS Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76·9 per cent) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (530 women, 29·1 per cent) and multicentric disease (372, 20·4 per cent). In total, 202 postmenopausal women with oestrogen receptor-positive (ER+) unifocal tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 173 women (85·6 per cent). Seventy-five women aged less than 70 years with human epidermal growth factor receptor 2-positive (HER2+) tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 45 women (60 per cent). CONCLUSION Most mastectomies are advised for large tumour to breast size ratio, but there is an inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. The application of standardized recommendations for NST could reduce the number of mastectomies advised by MDTs.
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24
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Feng Y, Flitcroft K, van Leeuwen MT, Elshaug AG, Spillane A, Pearson SA. Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ J Surg 2019; 89:1230-1235. [PMID: 31418524 PMCID: PMC6852512 DOI: 10.1111/ans.15381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
Background The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries. Methods We used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR. Results We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals. Conclusion Wide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.
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Affiliation(s)
- Yingyu Feng
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Flitcroft
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia
| | - Marina T van Leeuwen
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Units, The Mater Hospital, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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25
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Abstract
BACKGROUND The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care. METHODS The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included. RESULTS The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction. CONCLUSIONS Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
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26
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Oh DD, Flitcroft K, Brennan ME, Snook KL, Spillane AJ. Outcomes of breast reconstruction in older women: patterns of uptake and clinical outcomes in a large metropolitan practice. ANZ J Surg 2019; 89:706-711. [PMID: 31033164 DOI: 10.1111/ans.15145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older age is associated with lower rates of breast reconstruction (BR) following mastectomy. This study compared a range of factors in women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). METHODS An audit of 338 women aged 60 or over treated with mastectomy with (n = 86) or without (n = 252) BR for primary breast cancer from 2009 to 2016 was conducted. Demographic, tumour, treatment, comorbidity and surgical complication data were obtained from patient medical records. RESULTS NBR patients were associated with older age (P ≤ 0.001), more comorbidities (P = 0.038) and more extensive disease (P = 0.001) than BR patients. Total number of complications was not significantly different between BR and NBR patients (P = 0.286), or the different types of BR (P = 0.697). BR patients had higher rates of unplanned returns to the operating theatre, particularly in the late post-operative period (P = 0.025). Implant-based reconstruction was associated with more unplanned operating theatre returns than autologous reconstruction in the late post-operative period (P = 0.013). CONCLUSION Post-mastectomy BR in elderly patients has a clinical complication profile similar to NBR patients. This audit found no clinical-based reasons to not offer oncologically suitable and clinically fit elderly women the option of BR.
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Affiliation(s)
- Daniel D Oh
- Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia
| | - Kathy Flitcroft
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Meagan E Brennan
- Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Kylie L Snook
- Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Spillane
- Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
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27
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Campbell I, Lao C, Blackmore T, Edwards M, Hayes L, Ng A, Lawrenson R. Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand. ANZ J Surg 2018; 88:1263-1268. [DOI: 10.1111/ans.14840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Campbell
- School of Medicine; The University of Auckland; Auckland New Zealand
- Waikato District Health Board; Hamilton New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Tania Blackmore
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Melissa Edwards
- School of Medicine; The University of Auckland; Auckland New Zealand
| | - Louise Hayes
- Waikato District Health Board; Hamilton New Zealand
| | - Alex Ng
- Department of General Surgery, Auckland City Hospital; Auckland New Zealand
| | - Ross Lawrenson
- Waikato District Health Board; Hamilton New Zealand
- Medical Research Centre, University of Waikato; Hamilton New Zealand
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28
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Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer. Support Care Cancer 2018; 27:2135-2142. [PMID: 30251065 DOI: 10.1007/s00520-018-4470-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%. This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women's reconstruction decisions. METHODS Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic). RESULTS Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction. CONCLUSIONS Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients' decisions about breast reconstruction, especially for non-English speaking patients.
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29
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Oh DD, Flitcroft K, Brennan ME, Snook KL, Spillane AJ. Patient-reported outcomes of breast reconstruction in older women: Audit of a large metropolitan public/private practice in Sydney, Australia. Psychooncology 2018; 27:2815-2822. [PMID: 30225915 DOI: 10.1002/pon.4895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. This study compared patient-reported outcomes between women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). METHODS About 135 women aged 60 or over treated between 2009 and 2016 with mastectomy only (N = 87) or mastectomy with BR (N = 48) for primary breast cancer completed patient-reported outcome measures using a set of validated questionnaires. Reasons for choosing or declining BR were also explored using a set of nonvalidated questionnaires. RESULTS Patients who received BR were generally younger (P = <0.001) and reported greater satisfaction with their bodies (P = 0.048) than NBR patients. Patients with autologous reconstruction reported greater satisfaction with their breasts than implant-based reconstruction patients. Both BR and NBR patients reported good quality of life, low pain scores, good body image, and low levels of decisional regret. CONCLUSIONS These data do not identify any quality of life-related reasons to not offer clinically fit, well-informed older women the option of BR.
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Affiliation(s)
- Daniel D Oh
- Breast and Surgical Oncology, The Poche Centre, North Sydney, Australia
| | - Kathy Flitcroft
- Breast and Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Meagan E Brennan
- Breast and Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kylie L Snook
- Breast and Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,Mater Hospital, Sydney, Australia
| | - Andrew J Spillane
- Breast and Surgical Oncology, The Poche Centre, North Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia.,Mater Hospital, Sydney, Australia
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30
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Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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31
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Flitcroft KL, Brennan ME, Costa DSJ, Spillane AJ. Regional variation in immediate breast reconstruction in Australia. BJS Open 2017; 1:114-121. [PMID: 29951613 PMCID: PMC5989981 DOI: 10.1002/bjs5.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022] Open
Abstract
Background Breast reconstruction following mastectomy has proven benefits and is the standard of care in many high‐income countries. This audit documented regional variation in immediate breast reconstruction rates across Australia. Methods The Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit database and geospatial software were used to model the distribution of breast reconstructions performed on women having mastectomy in Australia in 2013. Geospatial mapping identified the distribution of these procedures in relation to the Greater Capital City Statistical Areas (GCCSAs) of the five largest states. Data were analysed using χ2 tests of independence and an independent‐samples t test. Results Of 3786 patients having a mastectomy, 692 underwent breast reconstruction of which 679 (98·1 per cent) were immediate reconstructions. Rates of reconstruction differed significantly between jurisdictions (χ2 = 164·90), and were significantly higher in GCCSAs (χ2 = 144·60) and private hospitals (χ2 = 50·72) (all P < 0·001). Immediate breast reconstruction was not reported for 43·8 per cent of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 29·8 per cent of hospitals within GCCSAs. A wider age range of women appeared to have had immediate reconstructions at hospitals within GCCSAs, although the difference in mean age between regions was not significant. Immediate breast reconstruction was considerably less likely to be performed in women who lived in areas of lower to mid socioeconomic status. Conclusion Variations in the rate of immediate breast reconstruction may not be purely resource‐driven.
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Affiliation(s)
- K L Flitcroft
- Breast and Surgical Oncology at the Poche Centre University of Sydney Sydney Australia.,Northern Clinical School University of Sydney Sydney Australia
| | - M E Brennan
- Breast and Surgical Oncology at the Poche Centre University of Sydney Sydney Australia.,Northern Clinical School University of Sydney Sydney Australia
| | - D S J Costa
- Pain Management Research Unit University of Sydney at Royal North Shore Hospital St Leonards, New South Wales Australia
| | - A J Spillane
- Breast and Surgical Oncology at the Poche Centre University of Sydney Sydney Australia.,Northern Clinical School University of Sydney Sydney Australia.,Surgical Oncology, Breast and Endocrine Surgery Department, Mater Hospital Sydney Australia.,Surgical Oncology, Breast and Endocrine Surgery Department, Royal North Shore Hospital St Leonards, New South Wales Australia
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32
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Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice. Qual Life Res 2017; 26:2287-2319. [PMID: 28397191 DOI: 10.1007/s11136-017-1555-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Many studies have explored women's reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women's reasons for choosing a range of BR options, including no BR, in different settings and across time. METHODS Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains. RESULTS While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal; Feeling/looking good; Being practical; Influence of others; Relationship expectations; Fear; Timing; and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers. CONCLUSIONS Understanding women's reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their individual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.
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