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Nor S, Chan KG, Rahman HA, H. Abdul-Mumin K. Patient satisfaction of breast reconstructive surgery following mastectomy in Brunei. PLoS One 2023; 18:e0289955. [PMID: 37611034 PMCID: PMC10446170 DOI: 10.1371/journal.pone.0289955] [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: 11/12/2022] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the impact of Breast Reconstructive Surgery (BRS) on patients' satisfaction and quality of life following mastectomy for breast cancer. METHODS A multi-method design study comprising quantitative and qualitative research was conducted between October to December 2019. The quantitative component consisted of a cross-sectional study using the Breast-Q questionnaire and the qualitative component involved in-depth interviews with eligible patients (N = 16) who underwent BRS following mastectomy for breast cancer. Quantitative analysis was performed including Fisher's exact test and One-way Analysis of Variance where a p-value of <0.05 was regarded as statistically significant. Qualitative data was thematically analysed using Braun and Clarke's thematic analysis. RESULTS 14 out of 16 eligible patients participated in the study. We observed the lowest-scale score was for 'satisfaction with nipples' (mean score 32.7), followed by 'physical well-being: abdomen' (mean score 69.5). Despite a median score of 70 for 'satisfaction with breasts', patients were satisfied with the overall outcome of BRS (median score 80.5). Thematic analysis yielded three themes i.e. "I feel beautiful again" that described patients' satisfaction with aesthetic outcome with autologous reconstruction; "Striving for normality" that indicated BRS established back a sense of normality and improve their self-confidence and lastly, "I was well taken care of" highlighted the importance of providing 'well-informed' care to ensure overall satisfaction of their BRS journey. CONCLUSION The uptake of BRS remains low since its availability in 2012, despite an overall increase in breast cancer cases in Brunei annually. Patients who underwent BRS have shown an increase BREAST-Q scores in breast satisfaction, psychosocial and sexual well-being after breast cancer treatment. Delivering high-quality patient-centred services and providing adequate information can influence the level of satisfaction for overall outcome. BRS should be considered as an important healthcare priority in Brunei and routinely be offered in the management of breast cancer.
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Affiliation(s)
- Shazana Nor
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- Department of Plastics Reconstructive Surgery, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Koo Guan Chan
- Department of Plastics Reconstructive Surgery, Ministry of Health, Bandar Seri Begawan, Brunei Darussalam
| | - Hanif Abdul Rahman
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Khadizah H. Abdul-Mumin
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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See MH, Sinnadurai S, Lai LL, Tan KL, Teh MS, Teoh LY, Jamaris S, Abdul Malik R, Bhoo-Pathy N. Outcomes after mastectomy with immediate breast reconstruction for breast cancer in a multiethnic, middle-income Asian setting. Surgery 2021; 170:1604-1609. [PMID: 34538341 DOI: 10.1016/j.surg.2021.08.001] [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: 09/03/2020] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although immediate breast reconstruction is increasingly becoming popular worldwide, evidence from resource-limited settings is scarce. We investigated factors associated with immediate breast reconstruction in a multiethnic, middle-income Asian setting. Short-term surgical complications, timing of initiation of chemotherapy, and survival outcomes were compared between women undergoing mastectomy alone and their counterparts receiving immediate breast reconstruction. METHODS This historical cohort study included women who underwent mastectomy after diagnosis with stage 0 to stage IIIa breast cancer from 2011 to 2015 in a tertiary hospital. Multivariable regression analyses were used to assess factors associated with immediate breast reconstruction and to measure clinical outcomes. RESULT Out of 790 patients with early breast cancer who had undergone mastectomy, only 68 (8.6%) received immediate breast reconstruction. Immediate breast reconstruction was independently associated with younger age at diagnosis, recent calendar years, Chinese ethnicity, higher education level, and invasive ductal carcinomas. Although immediate breast reconstruction was associated with a higher risk of short-term local surgical complications (adjusted odds ratio: 3.58 [95% confidence interval 1.75-7.30]), there were no significant differences in terms of delay in initiation of chemotherapy, 5-year disease-free survival, and 5-year overall survival between both groups in the multivariable analyses. CONCLUSION Although associated with short-term surgical complications, immediate breast reconstruction after mastectomy does not appear to be associated with delays in initiation of chemotherapy, recurrence, or mortality after breast cancer. These findings are valuable in facilitating shared surgical decision-making, improving access to immediate breast reconstruction, and setting priorities for surgical trainings in middle-income settings.
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Affiliation(s)
- Mee-Hoong See
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Siamala Sinnadurai
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Poland
| | - Lee-Lee Lai
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keh-Ling Tan
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mei-Sze Teh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li-Ying Teoh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suniza Jamaris
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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The Experiences and Support Needs of Women With Gestational Breast Cancer in Singapore: A Descriptive Qualitative Study. Cancer Nurs 2020; 45:E263-E269. [PMID: 33252405 DOI: 10.1097/ncc.0000000000000912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gestational breast cancer is diagnosed during pregnancy or within the first postpartum year. There is a lack of studies on the experiences of ethnically diverse Asian women with gestational breast cancer. OBJECTIVE The aim of this study was to explore the experiences of Asian women with gestational breast cancer so necessary support can be rendered. METHODS This qualitative descriptive study used purposive sampling to recruit 7 women with gestational breast cancer who were following up at the breast center of a tertiary women's hospital in Singapore. Semistructured, individual, face-to-face, audio-recorded interviews were used to explore the in-depth experiences of these women. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS Three main themes emerged from the thematic analysis: (1) being a sick woman, (2) juggling between being a mother and a patient, and (3) seeking normalcy. Women had to contend with disruptive changes from gestational breast cancer, both emotionally and physically. They were constantly distressed by their altered body images, and family support was vital to help these women cope with their treatments. Alternative support sources included healthcare professionals and the Internet. CONCLUSION Gestational breast cancer experiences varied based on the women's encounter perceptions and existing support. Their experiences may be improved through further support to mediate their coping efforts. Future quantitative and qualitative research should explore and evaluate the various aspects of the long-term disease and psychosocial effects of gestational breast cancer. IMPLICATIONS FOR PRACTICE Hospitals should include support strategies in antenatal classes and postnatal workshops to lessen disruptions of the motherhood experiences.
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Yang B, Ren G, Song E, Pan D, Zhang J, Wang Y, Liao N, Tang J, Wang X, Cui S, Jin F, Geng C, Sun Q, Li H, Fan Z, Cao X, Wang H, Wang S, Shao Z, Wu J. Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals. Oncologist 2020; 25:e1473-e1480. [PMID: 32333626 DOI: 10.1634/theoncologist.2020-0001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are limited nationwide data regarding breast cancer surgery in China. The Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons conducted a nationwide survey to examine the use of and barriers associated with surgical options among patients with breast cancer. METHODS Surveys were sent via e-mail to the directors of 110 centers that performed at least 200 breast cancer operations in 2017. The electronic questionnaire contained 183 questions and covered six aspects, including demographic information about the hospitals and surgeons, surgical practice, and application of breast reconstruction. RESULTS The selected hospitals were from 31 provinces or municipalities. The overall proportion of breast-conserving surgery (BCS) was 22%. Local gross domestic product was significantly related to the rate of BCS (p = .046). Sentinel lymph node biopsy was performed routinely in 76% of hospitals. Only 14.5% (16/110) of hospitals used the dual-tracer method, including radioisotopes. For patients with cN0 disease receiving BCS with one or two positive sentinel lymph nodes, 20% (22/110) of hospitals accepted omitting axillary lymph node dissection (ALND). For patients who underwent mastectomy, only 4% (4/110) of hospitals accepted omitting ALND. There was an obvious polarization trend in the proportion of oncoplastic breast-conserving surgery (OPS); 35/110 (32%) performed OPS in fewer than 10% of cases, whereas 36/110 (33%) performed OPS in more than 50% of cases. OPS was more likely to be performed in academic hospitals. Volume displacement was more commonly used than volume replacement (p < .001). Breast reconstruction was routinely performed in 96/110 (87%) of hospitals, 62% of which involved cooperation with the plastic surgery department. Factors influencing breast reconstruction after mastectomy included the establishment of a plastic surgery department, regional economy, and cooperation between the plastic and general surgery departments. Overall, the proportion of breast reconstruction procedures after mastectomy was 10.7%, with 70% being implant-based reconstruction, 17% autologous tissue reconstruction, and 13% a combination. Overall, 22% of the hospitals predominantly performed immediate breast reconstruction. For delayed reconstruction, two-stage implant-based breast reconstruction was the first choice for 46% of centers, whereas 20% of centers chose autologous reconstruction. Among the 96 centers that performed autologous-based reconstruction, 96% performed latissimus dorsi flap reconstruction, 65% performed transverse rectus abdominis musculocutaneous flap reconstruction, and 45% used deep inferior epigastric artery perforator flaps. CONCLUSION The results are of great value for promoting the implementation of a consensus on diagnostic and treatment standards, development of guidelines for breast cancer, and training of breast specialists. IMPLICATIONS FOR PRACTICE This study aimed to establish comprehensive baseline data on the status of current breast cancer treatment in China by presenting the statistics on clinical treatments and surgeries, the distribution of clinical stages, and the demographic characteristics of patients. This report is based on a survey conducted by the Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons, which examined the use of breast cancer surgical options in hospitals all over the country and the factors hindering the adoption of procedures and techniques. This study makes a significant contribution to the literature because there are limited nationwide data regarding breast cancer surgery in China.
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Affiliation(s)
- Benlong Yang
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
| | - Guosheng Ren
- Department of Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Erwei Song
- Breast Tumor Center, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Da Pan
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jing Zhang
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Yongsheng Wang
- Department of Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jinhai Tang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiang Wang
- Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Shude Cui
- Department of Breast Cancer, Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Feng Jin
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Cuizhi Geng
- Research Center and Tumor Research Institute, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Hongyuan Li
- Department of Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Xuchen Cao
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Haibo Wang
- Breast Center, Qingdao University Affiliated Hospital, Qingdao, Shandong Province, People's Republic of China
| | - Shu Wang
- Breast Disease Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhimin Shao
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
| | - Jiong Wu
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
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Salindera S, Ogilvy M, Spillane A. What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand? Breast 2020; 51:94-101. [PMID: 32252005 PMCID: PMC7375651 DOI: 10.1016/j.breast.2020.01.007] [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: 09/09/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To evaluate BreastSurgANZ members’ compliance at various threshold rates for 4 evaluable High-Quality Performance Indicators (HQPIs) introduced to improve patient care. To benchmark global best practice to assist in determining the eventual threshold standards. Method BreastSurgANZ Quality Audit data 2012–2016 & 2018 was used to determine rates of attainment through a range of thresholds for 4 HQPI’s. Rates were assessed for different volume surgeons and comparison made to international standards. Results 1.3761 patients needing mastectomy for in situ disease, if the threshold rate for immediate breast reconstruction (IBR) was ≥ 40% then 30% of all members and 78% of very high-volume surgeons achieved that rate, which is comparable to international recommendations. 2.26,007 patients requiring mastectomy, if the threshold rate for IBR was ≥ 20% then 28% of all surgeons and 78% very high-volume surgeons met the standard. This is below most international recommendations. 3. For 31,698 invasive tumours ≤ 2 cm, if the threshold rate for breast conservation was ≥ 70% then 64% of all surgeons met the standard; 70% is comparable internationally. 4.1382 women =<50 years if the threshold rate for neoadjuvant chemotherapy was set at ≥ 15% then 36% of surgeons complied; 15% is below most international recommendations. Conclusions Even at these modest thresholds there are low levels of achievement by BreastSurgANZ members with high volume surgeons more likely to comply. These thresholds are either comparable or lower than globally accepted standards. Members should strive to meet, even exceed these important goals as they are a metric of improved patient care. High quality performance indicators are important for driving improvements in care. Our threshold standards for IBR for insitu disease are comparable internationally. Threshold indicators for invasive breast cancer are well below international standards. Members are achieving internationally comparable rates of breast conservation. Use of neoadjuvant chemotherapy for women <50yrs is below international standards.
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Affiliation(s)
| | - Michelle Ogilvy
- Mortality & Morbidity Audits, Royal Australasian College of Surgeons, Australia
| | - Andrew Spillane
- University of Sydney, Royal North Shore Hospital Sydney, Australia; Surgical Oncology at the Poche Centre, Suite 2, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia.
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