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Malapati SH, Hyland CJ, Liang G, Edelen MO, Fazzalari A, Kaur MN, Bain PA, Mody GN, Pusic AL. Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review. J Patient Rep Outcomes 2024; 8:25. [PMID: 38416222 PMCID: PMC10899941 DOI: 10.1186/s41687-024-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs. METHODS MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively. RESULTS The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted. CONCLUSIONS Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.
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Affiliation(s)
- Sri Harshini Malapati
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Colby J Hyland
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - George Liang
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Maria O Edelen
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Amanda Fazzalari
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Gita N Mody
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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Newman L. Oncologic anthropology: Global variations in breast cancer risk, biology, and outcome. J Surg Oncol 2023; 128:959-966. [PMID: 37814598 DOI: 10.1002/jso.27459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
The global breast cancer burden is growing. Of 19.3 million new cancers diagnosed in 2020, 2.26 million were breast, surpassing lung as the most commonly diagnosed worldwide. Breast cancer is the fourth most common cause of cancer deaths worldwide, and the leading cause of death in females. Incidence and mortality rates are projected to rise disproportionately in low and middle-income countries, a consequence of socioeconomic factors and differences in tumor biology related to genetic ancestry.
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Affiliation(s)
- Lisa Newman
- Division of Breast Surgery, Interdisciplinary Breast Program, International Center for theStudy of Breast Cancer, Weill Cornell Medicine/New York Presbyterian Hospital Network, New York, New York, USA
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Alsubhi FS, Alothman MA, Alhadlaq AI. The International Awareness of Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5417. [PMID: 38025611 PMCID: PMC10659690 DOI: 10.1097/gox.0000000000005417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background To our knowledge, this is the first and largest study conducted to collect data among surgeons worldwide about breast reconstruction. We have aimed to collect data about breast reconstruction worldwide, the most popular breast reconstruction techniques, and the barriers behind the low rate of breast reconstruction according to surgeons. Methodology A comparative cross-sectional design was used in this study. A prepared questionnaire, which was developed after reviewing the literature review conducted for this study, was used to collect data. The questionnaire is multiple choice. It was distributed among surgeons online. Results The study includes 812 participants who live all over the world, representing 79 countries. More than a third of surgeons perform less than 10 breast reconstructions per year (33.38%), and 45.86% of them think that immediate surgery is the most frequent practice. A higher percentage of participants prefer implants over autologous reconstruction as a technique for breast reconstruction (54.9%). Moreover, 39.02% of participants shared that a lack of knowledge about the availability of breast reconstruction was a reason for refusing the surgery. Conclusions This study demonstrates that the breast reconstruction rate is still low and that most surgeons prefer implants that are performed immediately. The lack of knowledge among patients about the availability of breast reconstruction is the most common reason for refusing reconstruction. Therefore, there is a need to increase patient awareness about the availability of this surgery.
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Affiliation(s)
- Fatema S. Alsubhi
- From the Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed A. Alothman
- From the Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Hyland CJ, Olafsson S, Gadiraju G, Parikh N, Dey T, Broyles JM. Cost communication in cosmetic and reconstructive breast surgery: Public perceptions in the United States. J Plast Reconstr Aesthet Surg 2023; 83:126-133. [PMID: 37276730 DOI: 10.1016/j.bjps.2023.04.031] [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: 07/06/2022] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need to better understand the financial toxicity of surgery on patients. Recent data demonstrated that plastic surgeons seldom discuss out-of-pocket costs with patients. Not much is known regarding the public perceptions of out-of-pocket cost communication in reconstructive and cosmetic breast surgery. METHODS A cross-sectional survey was administered to adult women in the United States from November 2021 to December 2021 using Amazon Mechanical Turk. Perceptions regarding cost communication in plastic surgery were gathered. Incomplete responses were excluded. Multivariable models were used to identify predictors of responses. RESULTS There were 512 complete responses. Respondents had a mean age of 37.4 years. The majority strongly agreed or agreed that plastic surgeons should discuss out-of-pocket costs with patients undergoing implant-based breast reconstruction (85%), plastic surgeons should know the impact of surgery on patients' financial well-being (78%), and discussing costs was the most important aspect of the appointment (70%). Respondents who were unsure of their insurance status had lower odds of strongly agreeing or agreeing that surgeons should discuss out-of-pocket costs for autologous reconstruction (OR 0.12, CI 0.02-0.58, p = 0.01) and cosmetic breast augmentation (OR 0.14, CI 0.03-0.65, p = 0.01). Privately insured respondents had greater odds of strongly agreeing or agreeing to both, respectively (OR 2.21, CI 1.32-3.82, p < 0.01; OR 1.94, CI 1.17-3.31, p = 0.01) CONCLUSION: Many laywomen support the cost communication in plastic surgery and believe that plastic surgeons should know the impact of surgery on the patients' financial well-being, with variability among the sociodemographic groups. Plastic surgeons should strongly consider discussing costs with patients undergoing breast surgery.
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Affiliation(s)
- Colby J Hyland
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sigurast Olafsson
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Harvard Business School, Boston, MA, United States of America
| | - Goutam Gadiraju
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Neil Parikh
- Boston University School of Medicine, Boston, MA, United States of America
| | - Tanujit Dey
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Justin M Broyles
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
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Sadler SJ, Torio EF, Golby AJ. Global cancer surgery in low-resource settings: A strengths, weaknesses, opportunities, and threats analysis. Cancer 2023; 129:671-684. [PMID: 36597652 PMCID: PMC10069626 DOI: 10.1002/cncr.34630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023]
Abstract
Global cancer surgery is an essential and complex component of oncologic care. This study aims to describe global cancer surgery literature since the 2015 Lancet Commission on Global Surgery and Cancer Surgery and perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis. A systematic search was performed in PubMed of global cancer surgery articles. Themes were extracted from the included studies based on the following criteria: (1) performed in low- or low-middle-income countries, (2) published during or after 2015, (3) published in peer-reviewed journals, (4) written in the English language, and (5) accessible to the authors. Themes were further grouped into strengths, weaknesses, opportunities, and threats (SWOT analysis). The search strategy identified 154 articles published from 1992 to 2022. Forty-six articles were included in the qualitative synthesis and SWOT analysis. Recurring themes included local epidemiologic studies, local innovations and feasibility studies, prioritizing quality of life outcomes, multidisciplinary team approaches, limited resources, health system gaps, lack of economic analyses, diverse cancer management strategies and priorities, inter-setting collaboration, research expansion, the coronavirus disease 2019 pandemic, and unchecked technological advancements. These strengths, weaknesses, opportunities, and threats were described and related to the themes of research, surgical systems strengthening, economics and financing, and political framing of the 2015 Lancet Commission on Global Cancer Surgery. SWOT analyses of global cancer surgery may be helpful in suggesting future strategies for this expanding field. PLAIN LANGUAGE SUMMARY: Cancer surgery is a resource-intensive yet essential component of cancer care. In the face of projected growth of cancer burden, the present gap in cancer surgery care in low-resource settings with stressed health care and surgical infrastructure risks further exacerbation. We present a strengths, weaknesses, opportunities, and threats analysis of recent global cancer surgery literature pertaining to low-resource settings.
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Affiliation(s)
| | - Erickson F. Torio
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alexandra J. Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Access to Breast Reconstruction in Kuwait: Assessing Surgeon-related Factors as a Barrier to Referral. Plast Reconstr Surg Glob Open 2022; 10:e4633. [PMID: 36381485 PMCID: PMC9646627 DOI: 10.1097/gox.0000000000004633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/08/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED It is not uncommon for breast cancer patients to undergo a mastectomy without receiving or being presented with the option of having a breast reconstruction. With a low rate of breast reconstruction in Kuwait, we aim to assess physician-related factors as a barrier to referral. METHODS This is an online questionnaire-based study to investigate the variation in the referring general surgeons' knowledge and perception towards breast reconstructive surgery. RESULTS A total of 141 general surgeons responded to the questionnaire, and only 63 (44.7%) always discuss the available options for reconstruction with their breast cancer patients. When asked about referral to a plastic surgeon, only 49 (34.8%) responded with always, and the majority (N = 61; 43.3%) responded with sometimes. More than half (N = 73; 51.8%) believe that the general surgeon should determine patient suitability for referral to a plastic surgeon, while only 53 (37.6%) agree that breast cancer patients should always be referred to a plastic surgeon for consideration of reconstruction. The mean knowledge score was 6.6 of 8, while the mean perception score was 8.9 of 12. Responders with a higher total knowledge score were more likely to discuss with patients the availability of reconstruction. CONCLUSIONS Despite the acceptable knowledge scores in our general surgeons, there is a low rate of referral for breast reconstruction in Kuwait. There is a pressing need to generate legislations and a streamlined protocol for referral that facilitate access to breast reconstructive services.
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Michael A, Olawoye O, Ademola S, Ugwu E, Sarimiye F, Ayandipo O, Aderibigbe R, Iyun A, Oluwatosin O. Postmastectomy breast reconstruction awareness and attitudes in Nigerian women with breast cancer: A descriptive, cross sectional survey. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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