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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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2
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Tian Y, Birks S, Kemp S, Lee JC, Weymouth M, Serpell J, Walker M. Patterns of breast reconstruction and the influence of a surgical multidisciplinary clinic. ANZ J Surg 2024; 94:163-168. [PMID: 38071497 DOI: 10.1111/ans.18816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision. METHODS A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5-year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared. RESULTS Over the 10-year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups. CONCLUSION The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease.
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Affiliation(s)
- Yuan Tian
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Birks
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Sarah Kemp
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
| | - James C Lee
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
| | - Michael Weymouth
- Plastic Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Plastic and Reconstructive Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Melanie Walker
- Breast and Endocrine Surgery Unit, Alfred Health, Melbourne, Victoria, Australia
- Department of General Surgery, Monash Health, Clayton, Victoria, Australia
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Armanios AS, Nyandoro MG, Jayachitra N, Hamza S. Novel single-centre experience - evaluation of outcomes post-implementation of a coordinated combined breast reconstruction service. ANZ J Surg 2024; 94:156-162. [PMID: 37985578 DOI: 10.1111/ans.18783] [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: 04/26/2023] [Revised: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Autologous breast reconstruction services are logistically complex and challenging to implement but have better outcomes than implants. This study aimed to evaluate the effect of implementing a coordinated, low-cost combined breast reconstruction service (0.8 FTE nurse liaison, 0.25 FTE plastic surgeon, two dedicated breast surgeons 0.05 FTE each and protected weekly all-day oncoplastic theatre) on unit productivity and efficiency in reducing wait times for immediate autologous breast reconstruction. METHODS A retrospective cohort study was conducted on all patients who underwent immediate autologous breast reconstruction at Fiona Stanley Hospital between two study periods, pre-intervention - February 2016 to June 2019 and post-intervention - November 2022. Data were analysed using SPSS v.27. RESULTS One hundred twenty-seven participants were included, with 49% (n = 62) in the post-intervention group. Most procedures performed were therapeutic (n = 108, 85%). DIEP was the most common flap (84%), and the mean BMI was 26.9 (SD ± 4.2). There was a statistically significant increase in the number of high-risk gene carriers' prophylactic cases and bilateral cases performed post-intervention (5% to 26%, P = 0.001) and (29% to 55%, P = 0.003), respectively. Time to surgery on the waitlist did not significantly change after the intervention (therapeutic group: 3.1 to 3.5 weeks, P = 0.821; prophylactic group: 55.0 to 61.1 weeks, P = 1.000). Overall, there was a marked increase in the overall productivity of the breast service unit in terms of mastectomies, total reconstructions, and autologous reconstructions performed. CONCLUSIONS This single-centre experience showed that implementing a coordinated service significantly increased the unit's productivity. This low-cost intervention can be applied to other healthcare settings.
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Affiliation(s)
- Alexander S Armanios
- Breast Surgery Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Nisha Jayachitra
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Saud Hamza
- Breast Surgery Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Gunness P, Hamilton S, Capstick R, Masters J, Toma R. The development of a rural breast reconstruction service: patient reported outcomes and benefits. ANZ J Surg 2023; 93:1935-1937. [PMID: 36944602 DOI: 10.1111/ans.18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. RESULT Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. CONCLUSION Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.
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Affiliation(s)
- Preeya Gunness
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Sam Hamilton
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Capstick
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - John Masters
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
| | - Robert Toma
- Plastic and Reconstrutive Surgery, Warrnambool Plastic and Reconstructive Surgery, Warrnambool, Victoria, Australia
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Dayaratna N, Nguyen CL, Spillane A, Mak C, Warrier SK, Dusseldorp JR. Trends and variations in post-mastectomy breast reconstruction rates in Australia over 10 years. ANZ J Surg 2023; 93:242-250. [PMID: 36651629 DOI: 10.1111/ans.18243] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Offering breast reconstruction (BR) at the time of mastectomy is standard of care in Australia with proven quality-of-life benefits. Previously BR rates in Australia have been low compared to similar countries. Accurate up-to-date information is needed to promote equity in access to BR and inform future planning of services. This study analysed recent trends and variations of BR uptake in Australia. METHOD Data from the BreastSurgANZ Quality Audit (BQA) were used to identify patients who underwent mastectomy with or without reconstruction for invasive or in situ breast carcinoma from 2010 to 2019. The association between BR uptake and the variables of jurisdiction (state or territory), age, hospital type and remoteness, and remoteness of patients' home addresses were analysed. RESULTS A total 41 880 women underwent mastectomy between 2010 to 2019. The national BR rate steadily increased from 12.8% in 2010 to 29% in 2019, with a 10-year national average of 21.3%. Statistically significant differences in BR uptake (P < 0.001) were found between states with higher rates in New South Wales and Victoria, with BR more likely in private hospitals and in younger women (P < 0.001), and less likely in remote areas (P < 0.001). CONCLUSION The Australian BR rate has increased over the 10-year period, but significant variation still exists between states. BR is lower in older women and those living in regional and remote areas. While the steady increase in BR uptake is encouraging, barriers that exist to equitable provision of reconstructive surgical services for all women living with breast cancer still need to be corrected.
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Affiliation(s)
- Nirmal Dayaratna
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, Sydney, New South Wales, Australia.,The Mater Hospital, Sydney, New South Wales, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Kumar Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph R Dusseldorp
- Department of Breast Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Concord Repatriation Hospital, Sydney, New South Wales, Australia
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Sung N, Muthusamy A, Finn N, Stuart E, Fox J, Yeo B. Surgical management of breast cancer in Victoria: A state‐wide audit. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Nakjun Sung
- Melbourne Medical School University of Melbourne Melbourne Victoria Australia
| | - Arun Muthusamy
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
| | - Norah Finn
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Ella Stuart
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Jane Fox
- Department of Breast Services Monash Health Melbourne Victoria Australia
| | - Belinda Yeo
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
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Ho D, Chan E, Izwan S, Ng J, Teng R, Swindon D, Chang J. Uptake of breast reconstruction following mastectomy: a Gold Coast experience. ANZ J Surg 2022; 92:3011-3016. [PMID: 35426189 DOI: 10.1111/ans.17703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The breast reconstruction (BR) rate for women undergoing mastectomy for breast cancer management is 18% in Australia. The Australian Access to Breast Reconstruction Collaborative Group recommends that all women should have access to BR. This study presents BR uptake and outcomes from a breast surgical unit. METHODS A retrospective observational study identified women who had curative mastectomy for breast cancer between 1 January 2016 and 31 December 2021. Patient factors and surgical complications were compared between BR and no BR (NBR) patients. RESULTS Out of 929 women who had a curative mastectomy, 34% underwent reconstruction. Of this, 89% were immediate, and 11% were delayed. Reconstruction increased from 27% (2016) to 35% (2021). During this time, 588 women had a discussion for BR documented at their initial consultation, 58 after initial surgery and 283 were not documented. The rate of discussion prior to mastectomy increased from 38% to 74%. Women who had BR were more likely to be younger, premenopausal and less likely to be diabetic. Complications requiring return to theatre were higher in reconstructed women (13% vs. 7%). Overall, infected seroma, cellulitis requiring intravenous antibiotics and haematoma requiring drainage were comparable between both groups. CONCLUSION Our unit achieved a reconstruction rate of 34%, which is higher than national and international averages. Open discussion of reconstruction is crucial for women to make an informed decision. Further prospective studies exploring barriers to timely reconstruction will improve uptake of BR surgery and allow prioritization of BR services in Australia.
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Affiliation(s)
- Debbie Ho
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Erick Chan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Sara Izwan
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Justin Ng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
| | - Roy Teng
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Daisy Swindon
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- School of Medicine and Dentistry Griffith University Queensland Australia
| | - Jennifer Chang
- Department of Breast and General Surgery, Robina Hospital Gold Coast Hospital and Health Service Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Queensland Australia
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Lindsay D, Callander E. Quantifying the Costs to Different Funders over Five-Years for Women Diagnosed with Breast Cancer in Queensland, Australia: A Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412918. [PMID: 34948528 PMCID: PMC8701277 DOI: 10.3390/ijerph182412918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Individuals diagnosed with breast cancer have the highest rates of survival among all cancer types. Due to high survival, the costs of breast cancer to different healthcare funders are of interest. This study aimed to describe the cost to public hospital and private health funders and individuals due to hospital and emergency department (ED) admissions, as well Medicare items and pharmaceuticals over five years for Queensland women with breast cancer. We used a linked administrative dataset, CancerCostMod, limited to Queensland female breast cancer diagnoses between July 2011 and June 2013 aged 18 years or over who survived for 5 years (n = 5383). Each record was linked to Queensland Health Admitted Patient Data Collection, Emergency Department Information Systems, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between July 2011 and June 2018. Total costs for different healthcare funders as a result of breast cancer diagnoses were reported, with high costs and service use identified in the first six months following a breast cancer diagnosis. After the first six months post-diagnosis, the financial burdens incurred by different healthcare funders for breast cancer diagnoses in Queensland remain steady over a long period. Recommendations for reducing long term costs are discussed.
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Affiliation(s)
- Daniel Lindsay
- School of Public Health, The University of Queensland, Brisbane 4006, Australia
- Correspondence:
| | - Emily Callander
- School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia;
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