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Yun JY, Jeon DN, Jeon BJ, Kim EK. Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons. J Plast Reconstr Aesthet Surg 2024; 93:72-80. [PMID: 38670035 DOI: 10.1016/j.bjps.2024.04.016] [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: 12/11/2023] [Revised: 03/05/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR. METHODS Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons. RESULTS Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons. CONCLUSIONS This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.
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Affiliation(s)
- Ji Young Yun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Dong Nyeok Jeon
- Department of Plastic Surgery, Gangneung Asan Hospital, Gangneung, Korea
| | - Byung-Joon Jeon
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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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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Danko D, Liu Y, Geng F, Gillespie TW. Influencers of Immediate Postmastectomy Reconstruction: A National Cancer Database Analysis. Aesthet Surg J 2022; 42:NP297-NP311. [PMID: 34864860 DOI: 10.1093/asj/sjab415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The literature examining decision-making related to treatment and reconstruction for women with breast cancer has established that patient, clinical, and facility factors all play a role. OBJECTIVES The aim of this study was to use the National Cancer Database to determine how patient, clinical, and facility factors influence: (1) the receipt of immediate breast reconstruction; and (2) the type of immediate breast reconstruction received (implant-based, autologous, or a combination). METHODS A total of 638,772 female patients with breast cancers (Tis-T3, N0-N1, or M0) who between 2004 and 2017 received immediate reconstruction following mastectomy were identified in the National Cancer Database. Univariate and multivariate logistic regression models were applied to identify characteristics associated with immediate breast reconstruction and type of reconstruction. RESULTS Immediate breast reconstruction was more frequently associated with patients of White race, younger age, with private insurance, with lesser comorbidities, who resided in zip codes with higher median incomes or higher rates of high-school graduation, in urban areas, with Tis to T2 disease, or with involvement of <4 lymph nodes (all odds ratios [ORs] > 1.1). Negative predictors of immediate breast reconstruction were insurance status with Medicaid, Medicare, other government insurance, and none or unknown insurance (all ORs < 0.79). Implant-based reconstruction was associated with non-Black race, uninsured status, completion of higher education, undifferentiated disease, and stage T0 disease (all ORs > 1.10). CONCLUSIONS These findings confirm some previous studies on what patient, clinical, and facility factors affect decision-making, but also raise new questions that relate to the impact of third-party payer on receipt and type of reconstruction postmastectomy for breast cancer.
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Affiliation(s)
- Dora Danko
- Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Feifei Geng
- Rollins School of Public Health of Emory University, Atlanta, GA, USA
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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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Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making. Plast Reconstr Surg 2022; 149:629e-637e. [PMID: 35103641 DOI: 10.1097/prs.0000000000008903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding how medical experts and their patients process and transfer information is of critical importance for efficient health care provision. Behavioral economics has explored similar credence markets where economic incentives, information asymmetry, and cognitive bias can impact patient and surgeon choice. The aim of the current study is to explore how framing and behavioral bias affect elective restorative surgery decision-making, such as breast reconstruction following cancer treatment. METHODS The authors' study uses a cross-sectional survey data set of specialist surgeons (n = 53), breast care nurses (n = 101), and former or current breast cancer patients (n = 689). Data collected include participant demographics, medical history, a battery of cognitive bias tests, and a behavioral framing experiment. RESULTS This study finds statistically significant differences in breast reconstruction surgery preference by patients and nurses when decision options are framed in different ways (i.e., positively versus negatively). The authors' analysis of surgeons, nurses, and patients shows no statistically significant difference across eight common forms of cognitive bias. Rather, the authors find that the behavioral biases are prevalent to the same extent in each group. This may indicate that differences in experience and education seem not to mitigate biases that may affect patient choices and medical professional's recommendations. The authors' multivariate analysis identifies patient age (p < 0.0001), body mass index, and self-perceived health (p < 0.05) as negative correlates for choice of implant-based reconstruction. CONCLUSION For surgeons, nurses, and patients, the authors find uniform evidence of cognitive bias; more specifically, for patients and nurses, the authors find inconsistency in preference for type of surgical therapy chosen when alternative procedures are framed in different ways (i.e., framing bias).
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Surgical Services for Breast Cancer Patients in Australia, is There a Gap for Aboriginal and/or Torres Strait Islander Women? World J Surg 2021; 46:612-621. [PMID: 34557943 DOI: 10.1007/s00268-021-06310-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in Aboriginal and/or Torres Strait Islander women. When compared to other Australians, Aboriginal and/or Torres Strait Islander women have a higher breast cancer mortality rate. This systematic literature review examined disparities in breast cancer surgical access and outcomes for Aboriginal and/or Torres Strait Islander women. METHODS This systematic literature review, following the PRISMA guidelines, compared measures of breast cancer surgical care for Aboriginal and/or Torres Strait Islander people and other Australians. RESULTS The 13 included studies were largely state-based retrospective reviews of data collected prior to the year 2012. Eight studies reported more advanced breast cancer presentation among Aboriginal and/or Torres Strait Islander women. Despite the increased distance to a multidisciplinary, specialist team, there were no disparities in seeing a surgeon, or in the time from diagnosis to surgical treatment. Two studies reported disparities in the receipt of surgery and two reported no variations. Three studies reported disparities in the receipt of mastectomy versus breast conserving surgery, whilst four studies reported no variations. No studies examined postoperative surgical outcomes. CONCLUSIONS Aboriginal and/or Torres Strait Islander women present with more advanced breast cancer. There may be disparities in the receipt of surgery and the type of surgery. However, the metrics tested were not related to optimal care guidelines, and the databases utilised contain limited data on individual factors contributing to surgical care decisions. It is therefore difficult to determine whether the reported differences in the receipt of surgical care reflect disparate or appropriate care.
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Coudé Adam H, Docherty Skogh AC, Edsander Nord Å, Schultz I, Gahm J, Hall P, Frisell J, Halle M, de Boniface J. Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity. Breast 2021; 59:383-392. [PMID: 34438278 PMCID: PMC8390766 DOI: 10.1016/j.breast.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/15/2021] [Accepted: 07/03/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Overall survival in breast cancer patients receiving a delayed deep inferior epigastric perforator (DIEP) flap breast reconstruction is better than in those without delayed breast reconstruction. This study aimed at determining the impact of socioeconomic status (SES) and comorbidity on these observations. Materials and methods This matched cohort study included all consecutive women undergoing a delayed DIEP flap reconstruction at Karolinska University Hospital, Sweden, between 1999 and 2013. Controls had not received any delayed breast reconstruction and were relapse-free after a corresponding follow-up interval. Matching was by year of and age at mastectomy, tumour stage and lymph node status. Charlson Comorbidity Index (CCI) and socioeconomic data were obtained from national registers. Associations with breast cancer-specific (BCSS) and overall survival (OS) were investigated by Kaplan-Meier survival estimates and Cox proportional hazard regression analysis. Results Women in the DIEP group (N = 254) more often continued education after primary school (88.6% versus 82.6%, P = 0.026), belonged to the high-income group (76.0% versus 63.1%, P < 0.001), were in a partnership (57.1% versus 55.7%, P = 0.024) and healthier (median CCI 1.00 (range 0–13) versus 2.00 (range 0–16), P = 0.021) than the control group (N = 729). After adjustment for tumour and treatment factors, SES and comorbidity, OS remained significantly better for the DIEP group than the control group (HR 2.27, 95% CI 1.44–3.55). Conclusion Women with a delayed DIEP flap reconstruction are a subgroup of higher socioeconomic status and better health. Higher survival estimates for the DIEP group persisted after adjusting for those differences, suggesting the presence of further unmeasured covariates. Women with a delayed DIEP flap reconstruction have a higher socioeconomic status. They also have less comorbidity than women with no delayed reconstruction. Superior survival in DIEP patients is not eliminated by adjustments for such differences. Unmeasured selection to the reconstructive process may explain observed survival differences.
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Affiliation(s)
- H Coudé Adam
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - A C Docherty Skogh
- Department of Surgery, Breast Cancer Center, South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Å Edsander Nord
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - I Schultz
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J Gahm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, South General Hospital, Stockholm, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Halle
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St. Göran's Hospital, Stockholm, Sweden
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Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia. Breast Cancer Res Treat 2021; 188:547-560. [PMID: 33748922 PMCID: PMC8260537 DOI: 10.1007/s10549-021-06170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. METHODS A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan-Meier product-limit estimates and multivariate competing risk regression. RESULTS Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival. CONCLUSION This study provides benchmarks for monitoring future variations in treatment and survival.
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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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Unukovych D, Gümüscü R, Wärnberg F, de Boniface J, Eriksen C, Sund M, Nåsell P, Åhsberg K, Olofsson P, Lewin R, Lambe M, Brandberg Y, Folkvaljon F, Mani M. Breast reconstruction patterns from a Swedish nation-wide survey. Eur J Surg Oncol 2020; 46:1867-1873. [PMID: 32698944 DOI: 10.1016/j.ejso.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time. MATERIALS AND METHODS This is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test. RESULTS Mean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women. Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy. CONCLUSIONS To our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR.
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Affiliation(s)
- Dmytro Unukovych
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden; Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Rojda Gümüscü
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Sweden
| | - Jana de Boniface
- Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Eriksen
- Department of Clinical Science and Education, Southern General Hospital, Stockholm, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Petra Nåsell
- Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Kristina Åhsberg
- Department of Breast and Melanoma Surgery, Skåne University Hospital, Malmö Lund, Sweden
| | - Pia Olofsson
- Department of Hand Surgery and Plastic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Richard Lewin
- Department of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska Akademin, Gothenburg, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Folke Folkvaljon
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
| | - Maria Mani
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
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Hart SE, Momoh AO. Breast Reconstruction Disparities in the United States and Internationally. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00366-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Marouf A, Mortada H, Fakiha MG. Psychological, sociodemographic, and clinicopathological predictors of breast cancer patients' decision to undergo breast reconstruction after mastectomy. Saudi Med J 2020; 41:267-274. [PMID: 32114599 PMCID: PMC7841554 DOI: 10.15537/smj.2020.3.24946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/16/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine the influence of socioeconomic factors, anxiety, depression, and personality traits on the decision to undergo breast reconstruction (BR) post mastectomy. METHODS In this cross-sectional study, adult female breast cancer (BC) patients who had undergone a mastectomy between January 2017 and 2019 were interviewed using a 46-item questionnaire at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The questionnaire was divided into 5 sections: demographic data, personality traits, the Narcissism Index (NI), and the Hospital Anxiety and Depression Scale (HADS). Results: The sample (N=196; mean age: 48.44 [± 9.87] years, opted for BR: 60.2%, with chronic diseases: 36.7%, Saudi nationals: 43.9%) obtained means of 4.17 (± 2.81) on NI score, 7.72 (± 4.88) on anxiety score, and 5.78 (± 4.65) on depression score. Group differences in age, depression, lymph node involvement, and 2 personality traits emerged. CONCLUSION Age and depression significantly influenced the decision to undergo BR. Women who had opted for BR tended to be younger, be less depressed, and be characterized by lesser nodal involvement. Personality traits also influenced the decision to undergo BR. Diagnosing and treating depressed patients is an important component. A patient's age should not deter physicians from counselling them about BR.
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Affiliation(s)
- Azmi Marouf
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State. Plast Reconstr Surg 2020; 144:560-568. [PMID: 31461002 DOI: 10.1097/prs.0000000000005904] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. METHODS A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. RESULTS The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. CONCLUSIONS The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors' data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.
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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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15
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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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16
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Carl HM, Calotta NA, Siotos C, Bos TJ, Foster DG, Manahan MA, Cooney CM, Sacks JM, Rosson GD. Reconstruction options and outcomes for breast sarcoma patients. Breast J 2019; 25:702-705. [PMID: 31025484 DOI: 10.1111/tbj.13243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
Breast sarcomas constitute a rare and heterogeneous group of tumors. Given their aggressive nature and the potential for extensive resections, rates of reconstruction have been low. We retrospectively reviewed subjects derived from our institutional registry presented between 2003 and 2015. Thirty-four patients with primary breast sarcoma were identified. The average age was 51.9 years and the average follow-up was 58 months. The most common histological type was malignant phyllodes (61.8%). Two patients suffered cancer recurrence. Twelve patients (35.3%) underwent reconstruction. Four underwent implant-based reconstruction, seven had autologous-based reconstruction, and one had combined reconstruction. Major complications were one flap loss and one implant removal. Our relatively high rates of breast reconstruction suggest a newly increased willingness to offer reconstruction to this rarer patient population.
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Affiliation(s)
- Hannah M Carl
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Charalampos Siotos
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tobias J Bos
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Dennis G Foster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Michele A Manahan
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
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17
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Immediate Two-Stage Prosthetic Breast Reconstruction Failure: Radiation Is Not the Only Culprit. Plast Reconstr Surg 2018; 141:1315-1324. [PMID: 29750759 DOI: 10.1097/prs.0000000000004358] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immediate prosthetic breast reconstruction produces a satisfactory aesthetic result with high levels of patient satisfaction. However, with the broader indication for postmastectomy adjuvant radiation therapy, many patients are advised against immediate breast reconstruction because of concerns of implant loss and infection, particularly as most patients also require chemotherapy. This retrospective cohort study examines outcomes for patients who underwent immediate two-stage prosthetic breast reconstruction after mastectomy with or without adjuvant chemotherapy or radiotherapy. METHODS Between 1998 and 2010, 452 patients undergoing immediate two-stage prosthetic breast reconstruction involving a total of 562 breasts were included in this study. Stage 1 was defined as insertion of the temporary expander, and stage 2 was defined as insertion of the final silicone implant. Postoperative adjuvant radiotherapy was recommended with a tissue expander in situ for 114 patients. Complications, including loss of prosthesis, seroma, and infection, were recorded and analyzed. Cosmetic result was assessed using a four-point scale. RESULTS Postoperative prosthesis loss was 2.7 percent, 5.3 percent for patients undergoing adjuvant chemotherapy and increasing to 11.3 percent for patients receiving chemotherapy plus radiotherapy. Chemotherapy and radiotherapy independently were the main, statistically significant risk factors for expander or implant loss [incidence rate ratio, 13.85 (p = 0.012) and 2.23 (p = 0.027), respectively]. Prosthesis loss for patients undergoing combination chemotherapy plus radiotherapy was also significant [incidence rate ratio, 4.791 (p < 0.001)]. CONCLUSIONS These findings serve to better inform patients on risk in weighing treatment options. Postmastectomy radiation therapy doubles the risk of prosthesis loss over and above adjuvant chemotherapy but is an acceptable option following immediate two-stage prosthetic breast reconstruction in a multidisciplinary setting. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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18
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Braun B, Khil L, Tio J, Krause-Bergmann B, Fuhs A, Heidinger O, Hense HW. Differences in Breast Cancer Characteristics by Mammography Screening Participation or Non-Participation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:520-527. [PMID: 30149831 PMCID: PMC6131365 DOI: 10.3238/arztebl.2018.0520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of the German Mammography Screening Program (MSP) is to enable the early detection and less intensive treatment of breast cancer. We compared tumor characteristics and prognostic markers in breast cancers that were detected by screening in the MSP, in the interval after a negative screening, or among non-participants in screening. METHODS This retrospective series includes all of the 1531 cases of invasive and in situ breast cancer (DCIS, ductal carcinoma in situ) that were newly diagnosed in two certified breast care centers in Münster in the period 2006-2012 among women in the MSP target population. Complete information on the tumor characteristics, tumor biology, and primary surgical treatment were available for all cases. The mode of cancer detection was determined from the state cancer registry of North Rhine-Westphalia. Due to the retrospective design of this case series, there was no randomized allocation. RESULTS The 874 cases of breast cancer among MSP participants (714 detected by screening, 160 in the interval after a negative screen) and the 657 cases among non-participants arose in women of similar age (mean, 60.2 versus 59.3 years). MSP participants with breast cancer had DCIS more commonly than non-participants did (23% versus 13%); invasive carcinomas were smaller (74% versus 55% in the T1 stage), less commonly node-positive (25% versus 31%), less commonly high-grade (19% versus 27%), and less commonly triple-negative (7% versus 12%); MSP participants received neoadjuvant treatment less frequently (2% versus 8%) and more frequently underwent breast-conserving surgery (75% versus 62%). They less commonly had a guideline-based indication for adjuvant chemotherapy (46% versus 52%). CONCLUSION MSP participants with invasive breast cancer can generally be treated with less intensive surgical and systemic therapy than non-participants, even if interval cancers are also taken into account. Future studies should also investigate quality of life after a diagnosis of invasive carcinoma in screening participants.
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Affiliation(s)
- Bettina Braun
- Institute of Epidemiology and Social Medicine, University of Münster; State Cancer Registry of North Rhine-Westphalia, Bochum; Breast Care Center, Department of Gynecology and Obstetrics, University Hospital Münster; Department for Breast Diseases, St. Franziskus Hospital, Münster
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19
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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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20
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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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21
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Lyle G, Hendrie GA, Hendrie D. Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence. Int J Equity Health 2017; 16:182. [PMID: 29037209 PMCID: PMC5644132 DOI: 10.1186/s12939-017-0676-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum – namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. Methods An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. Results We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. Conclusions In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
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Affiliation(s)
- Greg Lyle
- Centre for Population Health Research, Curtin University, Perth, Australia.
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Australia
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22
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Abstract
BACKGROUND Although breast reconstruction has been shown to improve psychological, physical, and sexual well-being, Australia still has one of the lowest reconstruction rates among well-developed countries. This study explores both the quality-of-life benefits of reconstruction and the factors that influence patients' decisions of whether or not to undergo reconstruction. METHODS This retrospective cohort study (296 consecutive mastectomy patients from 2000 to 2010) uses an internationally validated questionnaire (BREAST-Q) to evaluate patients' satisfaction with or without breast reconstruction. In addition, we analyzed factors that influence patients' decisions of whether to undergo reconstruction. RESULTS Two hundred nineteen patients responded (74%) and of the 143 patients who elected to participate, 79 were in the "reconstruction group" and 64 in the "no-reconstruction group" post mastectomy. Patient demographics and cancer variables of the 2 groups were matched with the exception of age (reconstruction group 9.7 years younger: P < 0.01). The reconstruction group showed statistically significantly higher BREAST-Q scores with regard to satisfaction with the breast (P < 0.0001), psychological well-being (P = 0.0068), and sexual well-being (P = 0.0001). For the reconstruction group, the main reasons for undergoing reconstruction included improved self-image, more clothing choices, and the feeling of overcoming the cancer. One third of non-reconstructed patients still feared that reconstruction would mask cancer recurrence. CONCLUSION Our study confirms the positive effects of breast reconstruction post mastectomy and identifies reasons that influence patients' decisions of whether to undergo reconstruction. Breast reconstruction should be seen as an integral part in the comprehensive care of women with breast cancer and an important health care priority in Australia.
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23
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Sim N, Soh S, Ang CH, Hing CH, Lee HJ, Nallathamby V, Yap YL, Ong WC, Lim TC, Lim J. Breast reconstruction rate and profile in a Singapore patient population: a National University Hospital experience. Singapore Med J 2017; 59:300-304. [PMID: 28503698 DOI: 10.11622/smedj.2017035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Breast reconstruction is an integral part of breast cancer management with the aim of restoring a breast to its natural form. There is increasing awareness among women that it is a safe procedure and its benefits extend beyond aesthetics. Our aim was to establish the rate of breast reconstruction and provide an overview of the patients who underwent breast reconstruction at National University Hospital (NUH), Singapore. METHODS We evaluated factors that impact a patient's decision to proceed with breast reconstruction, such as ethnicity, age, time and type of implant. We retrospectively reviewed the medical records of women who had breast cancer and underwent breast surgery at NUH between 2001 and 2010. RESULTS The breast reconstruction rate in this study was 24.3%. There were 241 patients who underwent breast reconstruction surgeries (including delayed and immediate procedures) among 993 patients for whom mastectomies were done for breast cancer. Chinese patients were the largest ethnic group who underwent breast reconstruction after mastectomy (74.3%). Within a single ethnic patient group, Malay women had the largest proportion of women undergoing breast reconstruction (60.0%). The youngest woman in whom cancer was detected in our study was aged 20 years. Malay women showed the greatest preference for autologous tissue breast reconstruction (92.3%). The median age at cancer diagnosis of our cohort was 46 years. CONCLUSION We noted increases in the age of patients undergoing breast reconstruction and the proportion of breast reconstruction cases over the ten-year study period.
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Affiliation(s)
- Nadia Sim
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sharon Soh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuan Han Ang
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Chor Hoong Hing
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, National University Health System, Singapore
| | - Han Jing Lee
- Department of Surgery, National University Health System, Singapore.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Vigneswaran Nallathamby
- Department of Surgery, National University Health System, Singapore.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Yan Lin Yap
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Wei Chen Ong
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Thiam Chye Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Jane Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
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24
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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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25
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Matthews H, Carroll N, Renshaw D, Turner A, Park A, Skillman J, McCarthy K, Grunfeld EA. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction. Psychooncology 2017; 26:1860-1865. [PMID: 28195672 DOI: 10.1002/pon.4397] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction. METHODS Women who underwent post-mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of The BREAST-Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ-30 Questionnaire, The Patient and Observer Scar Assessment Scale, and a series of Visual-Analogue Scales. One hundredforty-eight women completed the questionnaire, a 56% response rate. RESULTS Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction, and 46% forquality of life. Psychosocial well-being emerged as a significant predictor of satisfaction with breast appearance (β = .322) and outcome satisfaction (β = .406). Deep inferior epigastric perforator flap patients reported greater satisfaction with breast appearance (β = .120) and outcome satisfaction (β = .167). CONCLUSIONS This study extends beyond the limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial well-being and reconstruction type. The findings also highlight the need for healthcare providers to consider the psychosocial well-being of patients both preoperatively and post operatively and provide preliminary evidence for the use of deep inferior epigastric perforator reconstructions over other types of reconstructive procedures.
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Affiliation(s)
- Hannah Matthews
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Derek Renshaw
- Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andrew Turner
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Alan Park
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jo Skillman
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kate McCarthy
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Elizabeth A Grunfeld
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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26
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Dasgupta P, Baade P, Youlden D, Garvey G, Aitken J, Wallington I, Chynoweth J, Zorbas H, Roder D, Youl P. Variations in outcomes for Indigenous women with breast cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12662] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2016] [Indexed: 02/06/2023]
Affiliation(s)
- P. Dasgupta
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - P.D. Baade
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Mathematical Sciences; Queensland University of Technology; Brisbane QLD Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
| | - D.R. Youlden
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - G. Garvey
- Menzies School of Health Research; Charles Darwin University; Brisbane Queensland Australia
| | - J.F. Aitken
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
- School of Population Health; University of Queensland; Brisbane Australia
- Institute for Resilient Regions; University of Southern Queensland; Toowoomba Australia
| | | | - J. Chynoweth
- Cancer Australia; Sydney New South Wales Australia
| | - H. Zorbas
- Cancer Australia; Sydney New South Wales Australia
| | - D. Roder
- Centre for Population Health Research; Samson Institute; University of South Australia; Adelaide SA Australia
| | - P.H. Youl
- Viertel Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Southport QLD Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Queensland Australia
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Dasgupta P, Youl PH, Pyke C, Aitken JF, Baade PD. Geographical disparity in breast reconstruction following mastectomy has reduced over time. ANZ J Surg 2016; 87:E183-E187. [DOI: 10.1111/ans.13710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Philippa H. Youl
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| | | | - Joanne F. Aitken
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Peter D. Baade
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
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Fei X, Christakos G, Lou Z, Ren Y, Liu Q, Wu J. Spatiotemporal Co-existence of Female Thyroid and Breast Cancers in Hangzhou, China. Sci Rep 2016; 6:28524. [PMID: 27341638 PMCID: PMC4920092 DOI: 10.1038/srep28524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022] Open
Abstract
Thyroid and breast cancers (TC, BC) are common female malignant tumors worldwide. Studies suggest that TC patients have a higher BC risk, and vice versa. However, it has not been investigated quantitatively if there is an association between the space-time TC and BC incidence distributions at the population level. This work aims to answer this question. 5358 TC and 8784 BC (female) cases were diagnosed in Hangzhou (China, 2008-2012). Pearson and Spearman rank correlation coefficients of the TC and BC incidences were high, and their patterns were geographically similar. The spatiotemporal co-existence of TC and BC distributions was investigated using the integrative disease predictability (IDP) criterion: if TC-BC association is part of the disease mapping knowledge bases, it should yield improved space-time incidence predictions. Improved TC (BC) incidence predictions were generated when integrating both TC and BC data than when using only TC (BC) data. IDP consistently demonstrated the spatiotemporal co-existence of TC and BC distributions throughout Hangzhou (2008-2012), which means that when the population experiences high incidences of one kind of cancer attention should be paid to the other kind of cancer too. The strength of TC-BC association was measured by the IDP coefficients and incidence prediction accuracy.
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Affiliation(s)
- Xufeng Fei
- College of Environmental and Resource Sciences, Zhejiang University, Hangzhou, China
| | - George Christakos
- Institute of Islands and Coastal Ecosystems, Zhejiang University, Zhoushan, China
- Department of Geography, San Diego State University, San Diego, CA, USA
| | - Zhaohan Lou
- Institute of Islands and Coastal Ecosystems, Zhejiang University, Zhoushan, China
| | - Yanjun Ren
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Qingmin Liu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Jiaping Wu
- Institute of Islands and Coastal Ecosystems, Zhejiang University, Zhoushan, China
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29
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Jeevan R, Mennie JC, Mohanna PN, O'Donoghue JM, Rainsbury RM, Cromwell DA. National trends and regional variation in immediate breast reconstruction rates. Br J Surg 2016; 103:1147-56. [PMID: 27324317 DOI: 10.1002/bjs.10161] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/18/2015] [Accepted: 02/16/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have identified variation in immediate reconstruction (IR) rates following mastectomy for breast cancer across English regions during a period of service reorganization, a national audit and changing guidelines. This study analysed current variations in regional rates of IR in England. METHODS Patient-level data from Hospital Episode Statistics were used to define a cohort of women who underwent primary mastectomy for invasive or in situ breast carcinoma in English National Health Service (NHS) hospitals between April 2000 and March 2014. A time series of IR rates was calculated nationally and within regions in 28 cancer networks. Regional IR rates before and after the national audit were compared, using logistic regression to adjust for patient demographics, tumour type, co-morbidity and year of mastectomy. RESULTS Between 2000 and 2014, a total of 167 343 women had a mastectomy. The national IR rate was stable at around 10 per cent until 2005; it then increased to 23·3 per cent by 2013-2014. Preaudit (before January 2008), adjusted cancer network-level IR rates ranged from 4·3 to 22·6 per cent. Postaudit (after April 2009) adjusted IR rates ranged from 13·1 to 36·7 per cent, with 20 networks having IR rates between 15 and 24 per cent. The degree of change was not greatest amongst those that started with the lowest IR rates, with four networks with the largest absolute increase also starting with relatively high IR rates. CONCLUSION The national IR rate increased throughout the study period. Substantial regional variation remains, although considerable time has elapsed since a period of service reorganization, guideline revision and a national audit.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - J C Mennie
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P N Mohanna
- Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M O'Donoghue
- Plastic and Reconstructive Surgery Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R M Rainsbury
- Department of Breast Surgery, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Moore SP, Soerjomataram I, Green AC, Garvey G, Martin J, Valery PC. Breast cancer diagnosis, patterns of care and burden of disease in Queensland, Australia (1998-2004): does being Indigenous make a difference? Int J Public Health 2016; 61:435-42. [PMID: 26427859 DOI: 10.1007/s00038-015-0739-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We compared patterns of care, comorbidity, disability-adjusted life-years (DALYs) and survival in Indigenous and non-Indigenous women with breast cancer in Queensland, Australia (1998-2004). METHODS A cohort study of Indigenous (n = 110) and non-Indigenous women (n = 105), frequency matched on age and remoteness. We used Pearson's Chi-squared analysis to compare proportions, hazard models to assess survival differences and calculated disability-adjusted life years (DALYs). RESULTS Indigenous women were more likely to be socially disadvantaged (43 vs. 20 %, p < 0.01) have comorbidity (42 vs. 18 % p < 0.01), and have regional spread or distant metastasis (metastasis, 51 vs. 36 %, p = 0.02) than non-Indigenous women; there was no difference in treatment patterns. More Indigenous women died in the follow-up period (p = 0.01). DALY's were 469 and 665 per 100,000 for Indigenous and non-Indigenous women, respectively, with a larger proportion of the burden attributed to premature death among the former (63 vs. 59 %). CONCLUSIONS Indigenous women with breast cancer received comparable treatment to their non-Indigenous counterparts. The higher proportion of DALYs related to early death in Indigenous women suggests higher fatality with breast cancer in this group. Later stage at diagnosis and higher comorbidity presence among Indigenous women reinforce the need for early detection and improved management of co-existing disease.
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Affiliation(s)
- Suzanne P Moore
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia.
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gail Garvey
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - Jennifer Martin
- School of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Patricia C Valery
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
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Awan BA, Samargandi OA, Alghamdi HA, Sayegh AA, Hakeem YJ, Merdad L, Merdad AA. The desire to utilize postmastectomy breast reconstruction in Saudi Arabian women. Predictors and barriers. Saudi Med J 2015; 36:304-9. [PMID: 25737172 PMCID: PMC4381014 DOI: 10.15537/smj.2015.3.10688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To study factors that influence the desire to utilize breast reconstruction after mastectomy, and to investigate the barriers to reconstruction among women in Saudi Arabia. Methods: We conducted a cross-sectional study at 2 surgical centers in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to all breast cancer patients attending the surgery clinics for follow-up after mastectomy between January and March 2013. Ninety-one patients met the study inclusion criteria. The first part of the questionnaire covered the demographic and socioeconomic information regarding factors that might influence the desire to utilize breast reconstruction including possible barriers. Multivariate logistic regression was used to determine the significant predictors of the desire to undergo reconstruction. Results: Overall, 16.5% of patients underwent breast reconstruction after mastectomy. Young age and high educational attainment were significantly associated with an increased desire to undergo reconstruction. The main barriers to reconstruction were the lack of adequate information on the procedure (63%), concerns on the complications of the procedure (68%), and concerns on the reconstruction interfering with the detection of recurrence (54%). Conclusion: Age and educational level were significant predictors of the desire to utilize breast reconstruction. Furthermore, modifiable barriers included the lack of knowledge and misconceptions on the procedure. Addressing these issues may increase the rate of breast reconstruction in Saudi Arabia.
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Affiliation(s)
- Basim A Awan
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Somogyi RB, Webb A, Baghdikian N, Stephenson J, Edward KL, Morrison W. Understanding the factors that influence breast reconstruction decision making in Australian women. Breast 2015; 24:124-30. [PMID: 25603922 DOI: 10.1016/j.breast.2014.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/11/2014] [Accepted: 11/22/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction. METHODOLOGY An online survey was distributed to breast cancer patients from Breast Cancer Network Australia. Results were tabulated, described qualitatively and analyzed for significance using a multiple logistic regression model. RESULTS 501 mastectomy patients completed surveys, of which 62% had undergone breast reconstruction. Factors that positively influenced likelihood of reconstruction included lower age, bilateral mastectomy, access to private hospitals, decreased home/work responsibilities, increased level of home support and early discussion of reconstructive options. Most common reasons for avoiding reconstruction included "I don't feel the need" and "I don't want more surgery". The most commonly sited sources of reconstruction information came from the breast surgeon followed by the plastic surgeon then the breast cancer nurse and the most influential of these was the plastic surgeon. CONCLUSIONS A model using factors easily obtained on clinical history can be used to understand likelihood of reconstruction. This knowledge may help identify barriers to reconstruction, ultimately improving the clinicians' ability to appropriately educate mastectomy patients and ensure effective decision making around breast reconstruction.
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Affiliation(s)
- Ron Barry Somogyi
- Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Angela Webb
- Division of Plastic & Reconstructive Surgery, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne, VIC 3002, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Nairy Baghdikian
- Cogentum Inc., Level 9, 45 William St, P.O. Box 50, Darling South, VIC 3145, Australia
| | - John Stephenson
- Department of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom
| | - Karen-Leigh Edward
- Australian Catholic University and St Vincent's Private Hospital, Melbourne Nursing Research Unit, Faculty of Health Sciences, Australian Catholic University, Locked Bag 4115, MDC, Fitzroy, VIC 3065, Australia
| | - Wayne Morrison
- The O'Brien Institute of Microsurgery, 42 Fitzroy St, Fitzroy, VIC 3065, Australia; Department of Plastic & Reconstructive Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Semple J, Metcalfe KA, Lynch HT, Kim-Sing C, Senter L, Pal T, Ainsworth P, Lubinski J, Tung N, Eng C, Gilchrist D, Blum J, Neuhausen SL, Singer CF, Ghadirian P, Sun P, Narod SA. International rates of breast reconstruction after prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol 2013; 20:3817-22. [PMID: 23740344 DOI: 10.1245/s10434-013-3040-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Breast reconstruction is an option for women with BRCA1 or BRCA2 mutations who elect to undergo prophylactic mastectomy to prevent breast cancer. We report on the uptake of breast reconstruction after prophylactic mastectomy in women with BRCA mutations from eight countries. METHODS Women with a BRCA1 or BRCA2 mutation were questioned regarding their cancer preventive practices. Information was recorded on prophylactic mastectomy and breast reconstruction. RESULTS A total of 1,635 women with a BRCA1 or BRCA2 mutation who elected to undergo prophylactic mastectomy from eight countries were included. A total of 1,137 women (69.5%) had breast reconstruction after prophylactic mastectomy. A total of 58.7% of women over the age of 45 years at the time of prophylactic mastectomy had breast reconstruction compared to 77.6% of women 35 years of age or younger [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.26-0.50, p < 0.001]. In addition, 62.9% of women with a breast cancer diagnosis (contralateral prophylactic mastectomy) had breast reconstruction after prophylactic mastectomy compared to 79.7% of women without a previous breast cancer diagnosis (OR 0.48, 95% CI 0.38-0.61, p < 0.001). A total of 66.9% of women from Canada had breast reconstruction after mastectomy compared to 71.9% of American women (OR 0.75, 95% CI 0.59-0.96, p = 0.02). CONCLUSIONS The majority of women elect for breast reconstruction after prophylactic mastectomy. However, younger women and those without a previous diagnosis of breast cancer are more likely to have breast reconstruction than older women or those with a previous diagnosis of cancer.
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Affiliation(s)
- John Semple
- Women's College Research Institute, Toronto, ON, Canada
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Brennan M, Spillane A. Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy – Systematic review. Eur J Surg Oncol 2013; 39:527-41. [DOI: 10.1016/j.ejso.2013.02.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/13/2013] [Accepted: 02/20/2013] [Indexed: 01/20/2023] Open
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Sinha S, Webb A, Morrison W. Manpower and economic issues in post-mastectomy breast reconstruction. ANZ J Surg 2013; 83:200-1. [PMID: 23675599 DOI: 10.1111/ans.12093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shiba Sinha
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Howard-McNatt MM. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit. BREAST CANCER-TARGETS AND THERAPY 2013; 5:9-15. [PMID: 24648753 DOI: 10.2147/bctt.s29142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms "reconstruction," "mastectomy," "rates," "benefits," and "breast cancer." Breast-reconstruction rates have continued to rise in recent years; however, there are definite barriers to widespread use of this procedure. These barriers include age, ethnicity, income, tumor characteristics, and the need for adjuvant radiation therapy. There are notable psychological advantages to women who receive breast reconstruction. These women also express an improved quality of life. Breast reconstruction is an acceptable technique for women undergoing mastectomy. It should be offered to all women in an immediate or delayed fashion, with guidance from their physician about the benefits and risks.
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Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia. Breast 2012; 21:394-400. [DOI: 10.1016/j.breast.2012.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/04/2012] [Accepted: 04/18/2012] [Indexed: 11/17/2022] Open
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Platt J, Baxter N, Zhong T. Breast reconstruction after mastectomy for breast cancer. CMAJ 2011; 183:2109-16. [PMID: 22065359 DOI: 10.1503/cmaj.110513] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jennica Platt
- Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, and Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
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Goldsbury DE, Smith DP, Armstrong BK, O'Connell DL. Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study. BMC Health Serv Res 2011; 11:253. [PMID: 21978077 PMCID: PMC3206422 DOI: 10.1186/1472-6963-11-253] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 10/06/2011] [Indexed: 11/15/2022] Open
Abstract
Background Population-based patterns of care studies are important for monitoring cancer care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. Our aim was to determine the accuracy of linked routinely collected administrative data for monitoring prostate cancer care in New South Wales (NSW), Australia. Methods The NSW Prostate Cancer Care and Outcomes Study (PCOS), a population-based survey of patterns of care for men aged less than 70 years diagnosed with prostate cancer in NSW, was linked to the NSW Cancer Registry, electronic hospital discharge records and Medicare and Pharmaceutical claims data from Medicare Australia. The main outcome measures were treatment with radical prostatectomy, any radiotherapy, external beam radiotherapy, brachytherapy or androgen deprivation therapy, and cancer staging. PCOS data were considered to represent the true treatment status. The sensitivity and specificity of the administrative data were estimated and relevant patient characteristics were compared using chi-squared tests. Results The validation data set comprised 1857 PCOS patients with treatment information linked to Cancer Registry records. Hospital and Medicare claims data combined described treatment more accurately than either one alone. The combined data accurately recorded radical prostatectomy (96% sensitivity) and brachytherapy (93% sensitivity), but not androgen deprivation therapy (76% sensitivity). External beam radiotherapy was rarely captured (5% sensitivity), but this was improved by including Medicare claims for radiation field setting or dosimetry (86% sensitivity). False positive rates were near 0%. Disease stage comparisons were limited by one-third of cases having unknown stage in the Cancer Registry. Administrative data recorded treatment more accurately for cases in urban areas. Conclusions Cancer Registry and hospital inpatient data accurately captured radical prostatectomy and brachytherapy treatment, but not external beam radiotherapy or disease stage. Medicare claims data substantially improved the accuracy with which all major treatments were recorded. These administrative data combined are valid for population-based studies of some aspects of prostate cancer care.
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Affiliation(s)
- David E Goldsbury
- Cancer Epidemiology Research Unit, Cancer Council NSW, PO Box 572, Kings Cross, NSW 1340, Australia.
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Moorin R, Gibson D, Bulsara CE, Holman CDJ. Challenging the perceptions of cancer service provision for the disadvantaged: evaluating utilisation of cancer support services in Western Australia. Support Care Cancer 2011; 20:1687-97. [PMID: 21947411 DOI: 10.1007/s00520-011-1262-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 09/05/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The main aim of the study was to evaluate the distributive utilisation of services provided by the Cancer Council of Western Australia according to age, social disadvantage and geographic location. Results were used to determine if social justice principles in terms of service provision were upheld. METHODS Cross-sectional study design to evaluate utilisation of cancer support services over a 12-week period in 2007 using administrative records. Service utilisation incidence rates (population information obtained from de-identified cancer registry data) and incidence rate ratios were calculated by gender, age group, cancer type, socioeconomic status and location. RESULTS The Information services (52%, n = 4,932) were the most popular Cancer Council of Western Australia (CCWA) services followed by Emotional Support services (21%, n = 2,045). All CCWA services were more likely to be accessed by those with a lower socioeconomic status, except for Clinical Services. The rate of utilisation for patients with cancer in the 65+ years age group was found to be under-serviced relative to the 40-64 years age group. CONCLUSIONS Overall, the study has shown that CCWA services are not provided uniformly (horizontal equity) across strata of socio-economic status. Given that the prevalence of cancer generally increases with socio-economic advantage, the findings were notable in regard to one particular outcome. Results for age indicate that there may be some underlying accessibility issues for the aged population. The findings are consistent with current literature highlighting issues of disadvantage in regard to the ability of elderly persons with cancer to access services and support.
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Affiliation(s)
- Rachael Moorin
- Department of Imaging and Applied Physics, Curtin University of Technology, Perth, WA, Australia
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"A struggle between vanity and life": the experience of receiving breast reconstruction in women of Taiwan. Cancer Nurs 2011; 33:E1-11. [PMID: 20467306 DOI: 10.1097/ncc.0b013e3181d1c853] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding the role of sociocultural factors on women's experiences of breast reconstruction is needed to provide better care and avoid erroneous assumptions of these women's needs. OBJECTIVE The purpose of this study was to understand the lived experiences of Taiwanese women with breast cancer who receive breast reconstruction following mastectomy in Taiwan. METHODS A qualitative research design, guided by the philosophy of hermeneutic phenomenology, was selected to guide the study. In-depth interviews were conducted 1 to 2 times with each participant and explored the women's experiences related to making decisions about, undergoing, and recovering from breast reconstruction. RESULTS Seven women who received either autologous breast reconstruction or saline implants were recruited in southern Taiwan. Five themes were identified, including "dream of a wonderful future," "unexpected reality," "struggling to accept," "balancing vanity with life priorities," and "coming to terms: no regret." CONCLUSION Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations. This ambivalence, combined with a culture that values selflessness and the placement of family first, resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. IMPLICATIONS FOR PRACTICE Clinical implications include the importance of regular and authentic patient-health care provider communication throughout the process of breast reconstruction, including recovery, and better acknowledgement of Taiwanese women's body image concerns associated with breast reconstruction.
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Hvilsom GB, Hölmich LR, Frederiksen K, Steding-Jessen M, Friis S, Dalton SO. Socioeconomic position and breast reconstruction in Danish women. Acta Oncol 2011; 50:265-73. [PMID: 21091086 DOI: 10.3109/0284186x.2010.529823] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Few studies have been conducted on the socioeconomic position of women undergoing breast reconstruction, and none have been conducted in the Danish population. We investigated the association between educational level and breast reconstruction in a nationwide cohort of Danish women with breast cancer. MATERIAL AND METHODS From nationwide registers, 13 379 women aged 30-80 years who had been treated by mastectomy for breast cancer in Denmark in 1999-2006 were identified and followed up through November 2009. Multivariate logistic regression models were used to investigate the simultaneous influence of educational level on the likelihood of having immediate or delayed (up to three years after mastectomy) breast reconstruction, with adjustment for age, breast cancer characteristics, comorbidity, socioeconomic variables and availability of plastic surgery services at each woman's affiliated hospital. RESULTS The odds ratios (ORs) for both immediate and delayed breast reconstruction increased significantly with level of education. Being affiliated to a hospital with a plastic surgery department increased the likelihood of both immediate (adjusted OR, 4.02; 95% confidence interval [CI], 2.81-5.75) and delayed breast reconstruction (adjusted OR, 1.41; 95% CI, 1.26-1.66). There was no association between education and breast reconstruction among 30-44 year old women, regardless of type of breast reconstruction; however, medium or higher education was significantly associated with a fourfold increase in the OR for immediate breast reconstruction in women aged 45-59 years and a more than twofold increase in the OR for delayed breast reconstruction in women aged 60-80 years compared to women with short education. CONCLUSION Increasing education was associated with increasing odds for having immediate or delayed breast reconstruction, but only in the older age groups. The offer of breast reconstruction appears to be unequally distributed in Denmark, and living in an area where the hospital has a plastic surgery department significantly increased the odds for having breast reconstruction.
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Chung IY, Kang E, Yang EJ, Lim JY, Kim EK, Kim HA, Noh WC, Kim JI, Park MH, Yoon JH, Lee JE, Nam SJ, Yang JH, Lee BK, Jung SH, Youn HJ, Kim KS, Jung SY, Moon BI, Kim SW. Survey of Psychosocial Problems Facing Breast Cancer Survivors after Undergoing a Mastectomy and Their Awareness of Breast Reconstruction. J Breast Cancer 2011. [DOI: 10.4048/jbc.2011.14.s.s70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Il Yong Chung
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Kang
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Woo Chul Noh
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jung Han Yoon
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Kil Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Hoo Jung
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Ku Sang Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Breast Care Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Burris JL, Andrykowski M. Disparities in mental health between rural and nonrural cancer survivors: a preliminary study. Psychooncology 2010; 19:637-45. [PMID: 19582800 PMCID: PMC2880195 DOI: 10.1002/pon.1600] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health (MH) outcomes among cancer survivors. The present study aims to identify disparities in MH outcomes between rural and nonrural cancer survivors. METHODS Cancer survivors who met eligibility criteria were identified through the Kentucky SEER Cancer Registry. Rural status was determined by 2003 USDA Rural-Urban Continuum Codes. 116 (n=54 rural, 62 nonrural) survivors with diagnoses of breast (n=42), hematologic (n=39), or colorectal (n=35) cancer completed mail-back questionnaires and/or a telephone interview. RESULTS Rural cancer survivors reported poorer MH functioning (effect size (ES)=0.45 SD), greater symptoms of anxiety (ES=0.70) and depression (ES=0.47), greater distress (ES=0.41), and more emotional problems (ES=0.47) than nonrural cancer survivors. Rural and nonrural cancer survivors did not differ consistently in regard to positive MH outcomes, such as benefit finding. The pattern of results was maintained when adjusted for education and physical functioning. CONCLUSIONS Clinically important disparities in MH outcomes were evident between rural and nonrural cancer survivors. Interventions aimed at raising access and utilization of MH services may be indicated for cancer survivors in rural areas.
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Affiliation(s)
- Jessica L. Burris
- University of Kentucky - Department of Psychology, Lexington, KY, USA
| | - Michael Andrykowski
- University of Kentucky - Department of Behavioral Science, Lexington, KY, USA
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Schlegel RJ, Talley AE, Molix LA, Bettencourt BA. Rural breast cancer patients, coping and depressive symptoms: A prospective comparison study. Psychol Health 2009; 24:933-48. [DOI: 10.1080/08870440802254613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Collections of routine, or ‘administrative’, hospital data have many applications in health care and are now recognised as valuable sources of information. In recent decades, administrative data have been seen primarily as funding and billing tools to assist with the reimbursement of hospitals for services provided; this purpose remains the primary focus of the clinical coder workforce. More recently, hospital data have been recognised as valuable resources for a range of health system improvement processes beyond funding. The focus of this paper is to review and demonstrate the diverse uses of administrative data in health services research and quality improvement. By gaining an understanding of how the data are used, we can appreciate the importance of good quality data from the perspective of its multiple uses. This paper describes a sample of the studies conducted in Australia using administrative data in health care improvement.
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Affiliation(s)
- Jude L Michel
- Jude L Michel BHIthlnfoManagt(Hons), Australian Centre for Economic Research on Health, (ACERH), School of Medicine, University of Queensland, Herston Road, Herston, Brisbane 4006 QLD, AUSTRALIA
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Hall SE, Holman CDJ, Threlfall T, Sheiner H, Phillips M, Katriss P, Forbes S. Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia. Aust J Rural Health 2009; 16:355-62. [PMID: 19032208 DOI: 10.1111/j.1440-1584.2008.01016.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study investigates if the pattern of diagnostic testing for suspected lung cancer, stage at diagnosis, patterns of specialist referral and treatment options offered to people in rural Western Australia are similar to those in the metropolitan area. It then explores the barriers to quality care in rural areas as perceived by GPs and patients. METHODS There was a review of GP records to obtain clinical and referral information and an in-depth interview with patients and GPs concerning their perspectives of the quality of care. RESULTS/DISCUSSION We selected age and sex-matched samples of 22 rural and 21 metropolitan patients. Rural patients had more symptoms and took longer to consult their GPs, leading to later diagnosis and fewer treatment options. They experienced longer waits for specialist consultation and underwent less diagnostic testing. The GPs always referred lung cancer patients to a specialist, usually a respiratory physician. Teaching hospitals were preferred because of their comprehensive facilities and multidisciplinary teams. Rural GPs reported distance, time and availability of appointments as barriers; they also raised concerns about late confirmation of diagnosis. Rural and metropolitan patients were equally satisfied with their quality of care, but rural patients desired more information and better communication between hospital and GPs. Facilities for rural patients at some metropolitan hospitals were criticised. In conclusion, rural patients received a different care pattern from metropolitan patients and they and their GPs raised concerns about the equity and quality of lung cancer care.
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Affiliation(s)
- Sonĵa E Hall
- School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
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Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncol 2008; 9:585-95. [PMID: 18510990 DOI: 10.1016/s1470-2045(08)70150-5] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An assessment of recent data on cancer in Indigenous Australians (Aborigines and Torres Strait Islanders) shows that, although they are less likely to have some types of cancer than other Australians, Indigenous people are significantly more likely to have cancers that have a poor prognosis, but are largely preventable, such as lung and liver cancer. Indigenous people with cancer are diagnosed at a later stage, are less likely to receive adequate treatment, and are more likely to die from their cancers than other Australians. Inadequate identification of Indigenous people in cancer registers precludes reporting for some parts of Australia, but sufficient information is available to identify priorities and inform appropriate remedial action. Health-risk factors, especially smoking, and inadequate health-system performance largely explain the patterns of cancer incidence and mortality in areas with adequate data. Effective tobacco control programmes, improvements across a range of health services, and meaningful Indigenous engagement are all needed to decrease the burden of cancer in Indigenous Australians.
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Affiliation(s)
- Joan Cunningham
- Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, Casuarina, NT, Australia
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50
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Newman C, Butow P, Knight R, McMillan K, Treloar C, Kippax S, Eades S. Cancer and Aboriginal people in Australia: A review of the literature. CRITICAL PUBLIC HEALTH 2008. [DOI: 10.1080/09581590701881615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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