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Vangsness KL, Juste J, Sam AP, Munabi N, Chu M, Agko M, Chang J, Carre AL. Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1169. [PMID: 39064597 PMCID: PMC11279340 DOI: 10.3390/medicina60071169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/19/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients.
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Affiliation(s)
- Kella L. Vangsness
- City of Hope, 1500 E Duarte Rd, Duarte, CA 91010, USA; (J.J.); (A.-P.S.); (N.M.); (M.C.); (M.A.); (J.C.); (A.L.C.)
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Rogers C, Cobb AN, Lloren JIC, Chaudhary LN, Johnson MK, Huang CC, Teshome M, Kong AL, Singh P, Cortina CS. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 2024; 203:317-328. [PMID: 37864105 PMCID: PMC10872271 DOI: 10.1007/s10549-023-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC). METHODS A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created. RESULTS 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01). CONCLUSION From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.
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Affiliation(s)
- Christine Rogers
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Adrienne N Cobb
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Jan I C Lloren
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Lubna N Chaudhary
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chiang-Ching Huang
- Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA
| | - Mediget Teshome
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Puneet Singh
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA.
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Wu S, Ma X, Zhang X, Yang C, Wang Y, Liu Y. Survival outcomes of autologous breast reconstruction after mastectomy: A matched case-control study. Front Oncol 2023; 12:1022925. [PMID: 36686843 PMCID: PMC9853161 DOI: 10.3389/fonc.2022.1022925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Background Due to the lack of strong evidence-based medical evidence, the relationship between autologous breast reconstruction (ABR) after mastectomy and long-term prognosis is unclear. This study aims to explore if ABR after mastectomy is associated with the prognosis of breast cancer (BC) patients based on the data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods We collected data for all cases diagnosed with BC who underwent or did not undergo ABR after mastectomy from 2010-2015 in the SEER database. The primary outcome of our study was overall survival (OS) and cancer specific survival (CSS). The Propensity Score-Matched (PSM) analysis was used to eliminate the effects of non-random statistics, setting the caliper as 0.0001 to balance the baseline variables within the groups. Chi-square test, Kaplan-Meier method, univariate and multivariate cox regression analysis were used to analyze the data and subgroup analysis was performed to find the subgroups of people who might benefit from ABR. Result Of 27893 eligible patients, 11038 patients were matched. The cohort consisted of 5519 (50%) ABR patients and 5519 (50%) non-ABR patients after PSM. After PSM, on multivariate cox regression analysis, ABR still exerted a significant influence on the OS (hazard ratio (HR), 0.83, P< 0.05). However, no statistical difference was shown on CSS (HR, 0.93, P = 0.31). Kaplan-Meier survival analysis showed ABR group had better OS (P = 0.001), but similar CSS (P = 0.174) between ARB and mastectomy groups. Subgroup analysis showed that after matching, those with 50-59 years old, earlier stages of disease, without a marital partner and living in urban areas had better OS after ABR. Conclusions ABR after mastectomy was associated with better OS, but not affect CSS.
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Affiliation(s)
- Shang Wu
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Xindi Ma
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Xiangmei Zhang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Chao Yang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Yubin Wang
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China
| | - Yunjiang Liu
- Breast Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China,Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Hebei Medical University, Shijiazhuang, China,*Correspondence: Yunjiang Liu,
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Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2022; 9:2323-2333. [PMID: 34647274 DOI: 10.1007/s40615-021-01169-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. METHODS Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. RESULTS African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. CONCLUSIONS We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.
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Victoria M, Marie B, Dominique R, Caroline A, Marc-Karim BD, Julien M, Sophie L, Anne-Déborah B. Breast reconstruction and quality of life five years after cancer diagnosis: VICAN French National cohort. Breast Cancer Res Treat 2022; 194:449-461. [PMID: 35608713 DOI: 10.1007/s10549-022-06626-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/03/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Women with breast cancer (BC) who have a mastectomy may subsequently undergo breast reconstruction (BR). This study aimed to identify (1) factors associated with having BR, (2) factors associated with immediate BR (IBR) and delayed BR (DBR), and (3) associations between no BR, IBR and DBR and physical and mental quality of life (QoL) 5 years after diagnosis. METHODS Analyses were based on data from the national French cancer cohort VICAN, which followed a representative sample of cancer survivors, including BC survivors, for 5 years after diagnosis. BR and BR type (IBR/DBR) were identified using medico-administrative databases. The SF12 scale was used to measure mental and physical QoL. Multivariate logistic regressions were used to identify factors associated with BR, and linear models to evaluate associations between BR and BR type with QoL. RESULTS Of the 1192 BC survivors in VICAN, 32.6% (n = 388) had a mastectomy. Among them, 60.1% (n = 233) had BR. Of these, 38.6% (n = 90) and 61.4% (n = 143) had IBR and DBR, respectively. Compared with women who had BR, women who did not were more likely to be older and to have a lower level of health literacy. Compared with women who did not have BR, those with IBR had better mental QoL, while those who had either IBR or DBR had better physical QoL. CONCLUSION Older women and those with inadequate health literacy were less likely to have BR. This may reflect women's preferences, inequalities in care options offered after a mastectomy, and socioeconomic barriers to accessing BR. These issues need further exploration. Furthermore, BR was associated with a better long-term physical QoL. IBR was associated with better mental QoL and should be promoted when possible.
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Affiliation(s)
- Memoli Victoria
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | - Bannier Marie
- Department of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - Rey Dominique
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | | | - Ben Diane Marc-Karim
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
| | - Mancini Julien
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France.
- APHM, BIOSTIC, Hop Timone, Marseille, France.
| | - Lauzier Sophie
- Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Bouhnik Anne-Déborah
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Cancer Biomedicine & Society Group, Equipe Labellisée Ligue 2019, 13009, Marseille, BDR, France
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Le Blanc J, Golshan M, Lannin D, Greenup R, Berger ER, Saridakis A, Horowitz N, Zanieski G, Avraham T, Mastrioanni M, Park T. Association of Medicaid Expansion with Post-mastectomy Reconstruction Rates. Ann Surg Oncol 2022; 29:2181-2189. [DOI: 10.1245/s10434-021-10858-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022]
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Adipose-Derived Stem Cell Features and MCF-7. Cells 2021; 10:cells10071754. [PMID: 34359925 PMCID: PMC8307920 DOI: 10.3390/cells10071754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 01/04/2023] Open
Abstract
Human adipose tissue-derived stem cells (hADSCs) are highly suitable for regeneration therapies being easily collected and propagated in vitro. The effects of different external factors and culturing conditions are able to affect hADSC proliferation, senescence, differentiation, and migration, even at the molecular level. In the present paper, we exposed hADSCs to an exhausted medium from the breast cancer cell line (MCF-7) to evaluate whether the soluble factors released by these cells may be able to induce changes in stem cell behavior. In particular, we investigated the expression of stemness-related genes (OCT4; Sox 2; Nanog), the cell-cycle regulators p21 (WAF1/CIP1) p53, epigenetic markers (DNMT1 and Sirt1), and autophagy-related proteins. From our results, we can infer that the exhausted medium from MCF-7 is able to influence the hADSCs behavior increasing the expression of stemness-related genes, cell proliferation, and autophagy. Polyamines detectable in MCF-7 exhausted medium could be related to the higher proliferation capability observed in hADSCs, suggesting direct crosstalk between these molecules and the observed changes in stem cell potency.
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Connors SK, Leal IM, Nitturi V, Iwundu CN, Maza V, Reyes S, Acquati C, Reitzel LR. Empowered Choices: African-American Women's Breast Reconstruction Decisions. Am J Health Behav 2021; 45:352-370. [PMID: 33888195 PMCID: PMC8383809 DOI: 10.5993/ajhb.45.2.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.
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Affiliation(s)
- Shahnjayla K Connors
- Shahnjayla K. Connors, Assistant Professor, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Isabel Martinez Leal
- Isabel Martinez Leal, Research Associate II, Social and Behavioral Science, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States;,
| | - Vijay Nitturi
- Vijay Nitturi, Research Assistant, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
| | - Chisom N Iwundu
- Chisom N. Iwundu, Postdoctoral Fellow, Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, United States
| | - Valentina Maza
- Valentina Maza, Research Assistant, Department of Psychological, Health, and Learning Sciences, University, Houston, Houston, TX, United States
| | - Stacey Reyes
- Stacey Reyes, Research Assistant, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chiara Acquati
- Chiara Acquati, Assistant Professor, Graduate College of Social Work, University of Houston, Houston, TX, United States
| | - Lorraine R Reitzel
- Lorraine R. Reitzel, Professor, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
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Babatunde OA, Eberth JM, Felder T, Moran R, Truman S, Hebert JR, Zhang J, Adams SA. Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women. J Racial Ethn Health Disparities 2021; 8:147-156. [PMID: 32385849 PMCID: PMC7648729 DOI: 10.1007/s40615-020-00766-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs. METHODS We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models. RESULTS There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women. CONCLUSIONS To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
| | - Jan M Eberth
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Tisha Felder
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
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Bajonero-Canonico P, Ferrigno AS, Saldaña-Rodriguez JA, Hinojosa-Gonzalez DE, de la O-Maldonado CG, de la Cruz-de la Cruz C, Moreno-Jaime B, Hernandez-Pavon M, Moral-de la Rubia J, Miaja-Avila M, Villarreal-Garza C. Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center. Support Care Cancer 2020; 29:2679-2688. [PMID: 32975644 DOI: 10.1007/s00520-020-05784-4] [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: 07/02/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. METHODS Women with stage I-III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. RESULTS A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. CONCLUSIONS Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.
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Affiliation(s)
- Paulina Bajonero-Canonico
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | | | | | | | - Brizio Moreno-Jaime
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Mariela Hernandez-Pavon
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Jose Moral-de la Rubia
- Psychology Department, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Melina Miaja-Avila
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico. .,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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Siotos C, Lagiou P, Cheah MA, Bello RJ, Orfanos P, Payne RM, Broderick KP, Aliu O, Habibi M, Cooney CM, Naska A, Rosson GD. Determinants of receiving immediate breast reconstruction: An analysis of patient characteristics at a tertiary care center in the US. Surg Oncol 2020; 34:1-6. [PMID: 32103789 DOI: 10.1016/j.suronc.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast reconstruction is an option for women undergoing mastectomy for breast cancer. Previous studies have reported underutilization of reconstructive surgery. This study aims to examine the role demographic, clinical and socio-economic factors may have on patients' decisions to undergo breast reconstruction. METHODS We analyzed data from our institutional database. Using multivariable and multinomial logistic regression, we compared breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction). RESULTS We analyzed data on 1459 women who underwent mastectomy during the period 2003-2015. Of these, 475 (32.6%) underwent mastectomy-only and 984 (67.4%) also underwent immediate breast reconstruction. After adjusting for potential confounders, older age (OR = 0.18, 95%CI:0.08-0.40), Asian race (OR = 0.29, 95%CI:0.19-0.45), bilateral mastectomy (OR = 0.71, 95%CI:0.56-0.90), and higher stage of disease (OR = 0.44, 95%CI:0.26-0.74) were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. There was no evidence for changes over time in the way socio-demographic and clinical factors were related to receiving immediate breast reconstruction after mastectomy. CONCLUSIONS Clinical characteristics, sociodemographic factors like age, race and insurance coverage affect the decision for reconstructive surgery following mastectomy.
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Affiliation(s)
- Charalampos Siotos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Michael A Cheah
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Ricardo J Bello
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287; Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Phillipos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Rachael M Payne
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 115 27, Greece
| | - Gedge D Rosson
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 N. Caroline Street, Baltimore, 21287, Maryland, USA, 21287
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12
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DeCoster RC, Bautista RMF, Burns JC, Dugan AJ, Edmunds RW, Rinker BD, Webster JM, Vasconez HC. Rural-Urban Differences in Breast Reconstruction Utilization Following Oncologic Resection. J Rural Health 2019; 36:347-354. [PMID: 31508853 DOI: 10.1111/jrh.12396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast reconstruction (BR) is the reconstructive surgical technique that focuses on restoring normal form and function to the breast following oncologic resection. The goal of this study was to determine if BR disparities exist among rural female patients in Kentucky. METHODS A retrospective (2006-2015), population-based cohort study was conducted on breast cancer patients (stages I-III) treated with mastectomy with or without BR. We used 2013 Beale codes to stratify patients according to geographic status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease, and treatment factors was used to predict BR. The likelihood of BR was reported in odds ratios (OR) using a 95% confidence interval (CI). RESULTS Overall, 10,032 patients met study criteria. Of those, 2,159 (21.5%) underwent BR. The rate of BR among urban, near-metro, and rural patients was 31.1%, 20.4%, and 13.4%, respectively (P < .001). Multivariate analysis revealed that women from near metro (OR 0.54, CI: 0.47-0.61; P < .001) and rural areas (OR 0.36, CI: 0.31-0.41; P < .001) were less likely to undergo BR than women from urban areas. CONCLUSION Although BR benefits are well documented, women from rural Kentucky undergo BR at lower rates and are less likely to receive BR than their urban counterparts. Efforts should seek to promote equitable access to BR for all patients, including those from rural areas.
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Affiliation(s)
- Ryan C DeCoster
- Lucille P. Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Robert-Marlo F Bautista
- Lucille P. Markey Cancer Center, University of Kentucky, Lexington, Kentucky.,Department of Surgery, Division of General Surgery, University of Kentucky, Lexington, Kentucky
| | - Jack C Burns
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Adam J Dugan
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - R Wesley Edmunds
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, Kentucky
| | - Brian D Rinker
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, Florida
| | - J Matthew Webster
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Henry C Vasconez
- Department of Surgery, Division of General Surgery, University of Kentucky, Lexington, Kentucky
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13
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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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14
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Svee A, Mani M, Sandquist K, Audolfsson T, Folkvaljon Y, Isern AE, Ringberg A, Manjer J, Falk-Delgado A, Wärnberg F. Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap. Br J Surg 2018; 105:1446-1453. [PMID: 29999520 DOI: 10.1002/bjs.10888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/25/2018] [Accepted: 04/07/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. METHODS This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/-3 years), age at diagnosis (+/-5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. RESULTS There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). CONCLUSION There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.
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Affiliation(s)
- A Svee
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - M Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - K Sandquist
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - T Audolfsson
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Y Folkvaljon
- Department of Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - A E Isern
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Volvat Stokkan, Trondheim, Norway
| | - A Ringberg
- Department of Plastic and Reconstructive Surgery, Lund University, Malmö, Sweden
| | - J Manjer
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - A Falk-Delgado
- Department of Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - F Wärnberg
- Department of Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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15
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Siotos C, Sebai ME, Wan EL, Bello RJ, Habibi M, Cooney DS, Manahan MA, Cooney CM, Seal SM, Rosson GD. Breast reconstruction and risk of arm lymphedema development: A meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:807-818. [DOI: 10.1016/j.bjps.2018.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 11/15/2022]
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16
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Soni SE, Lee MC, Gwede CK. Disparities in Use and Access to Postmastectomy Breast Reconstruction Among African American Women: A Targeted Review of the Literature. Cancer Control 2018; 24:1073274817729053. [PMID: 28975838 PMCID: PMC5937234 DOI: 10.1177/1073274817729053] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Postmastectomy breast reconstruction is a therapy that has been shown to have positive
psychological effects on its recipients. There is evidence that racial disparities in its
use exist, particularly among African American (AA) women. The purpose of this targeted
review of the literature was to examine the use of postmastectomy breast reconstruction
among AA women and to explore factors that contribute to such disparities. Published
literature that evaluated rates of breast reconstruction in AA women, as well as barriers
to reconstruction in this population, was reviewed. All of the reviewed data consisted of
retrospective studies. There are conflicting data in the literature regarding disparities
in the rates of postmastectomy breast reconstruction among AA women. However, a majority
of studies found that AA women were less likely (odds ratios: 0.36-0.71) to receive
postmastectomy breast reconstruction compared to white women. System-associated factors,
physician-associated factors, and patient-associated factors interact in a complex manner
that contributes to the reported disparities. Although there are trends suggesting racial
disparities in the rates of postmastectomy breast reconstruction exist, the published data
are retrospective and are inherently limited. The pursuit of breast reconstruction is
highly individual and involves multiple factors that interact in a complex manner. To this
end, prospective studies encompassing sociodemographic factors, clinical factors, and
patient preferences are necessary to determine what interventions by physicians can have
the greatest impact in ensuring equal access to this therapy when it is desired.
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Affiliation(s)
- Sara E Soni
- 1 Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - M Catherine Lee
- 1 Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,2 The Comprehensive Breast Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Clement K Gwede
- 3 Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,4 Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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17
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Newman LA. Breast Cancer Disparities: Socioeconomic Factors versus Biology. Ann Surg Oncol 2017; 24:2869-2875. [DOI: 10.1245/s10434-017-5977-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 12/22/2022]
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18
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Holliday TL, Suggs PD, Thompson SN, Richmond BK. Disparities in Rural Breast Cancer Care: Factors Affecting Choice of Breast Reconstruction in a West Virginia Tertiary Care Hospital. Am Surg 2017. [DOI: 10.1177/000313481708300727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The decision to pursue immediate postmastectomy breast reconstruction (IBR) is not uniform across all groups of women in the United States. We sought to investigate if the challenges of caring for a socioeconomically and geographically challenged rural population affected the incidence of IBR and to identify predictive factors of IBR in this population. Using our institution's cancer registry, we conducted a 10-year review of women with early-stage, unilateral breast cancer who received mastectomy. Demographics, insurance status, comorbidities, and surgeon graduation year were compared for patients receiving IBR versus no reconstruction. Variables with P < 0.05 on univariate analysis were included into a multivariate logistic regression model to determine independent predictors of IBR. From 2006 to 2015, 53/423 (12.5%) patients underwent IBR. On multivariate analysis, three factors independently predicted the decision to undergo IBR: age (P = 0.004), insurance type (P = 0.034), and use of contralateral prophylactic mastectomy (CPM, P < 0.001). Our data indicate that age, insurance type, and utilization of CPM influence the decision to pursue reconstruction. Additionally, the rate of IBR was found to be much lower in our West Virginia population than reported nationally, suggesting disparities in the care of women with early-stage, unilateral breast cancer in a rural population, even in a tertiary care environment.
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Affiliation(s)
- Tyler L. Holliday
- West Virginia University School of Medicine–Charleston Division, Charleston, West Virginia
| | - Patrick D. Suggs
- West Virginia University School of Medicine–Charleston Division, Charleston, West Virginia
| | - Stephanie N. Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
| | - Bryan K. Richmond
- Department of Surgery, West Virginia University Charleston Division, Charleston, West Virginia
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19
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Fasse L, Flahault C, Vioulac C, Lamore K, Van Wersch A, Quintard B, Untas A. The decision-making process for breast reconstruction after cancer surgery: Representations of heterosexual couples in long-standing relationships. Br J Health Psychol 2017; 22:254-269. [PMID: 28127844 DOI: 10.1111/bjhp.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. To our knowledge, no research has studied the involvement of the partner in the decision-making process regarding breast reconstruction (BR) after cancer. This study aimed to gain a better understanding of the couples' decision-making process for BR in the cancer context and particularly to investigate the partners' involvement in this process. METHOD Eighteen participants (nine women who underwent a mastectomy following a first breast cancer and their intimate partners) took part in this study. We conducted semidirective interviews, and a general inductive approach was chosen to capture the representations of the couples. RESULTS The women in the sample were aged between 33 and 66 years (M = 54, SD = 7.5) and their partner between 40 and 76 years (M = 59, SD = 11.6). The duration of their intimate relationship was on average 18 years (SD = 10.4; minimum = 4; maximum = 33). The analysis revealed 11 major themes. The two most salient ones were 'external influence' and 'implication of the partner'. The exploration of the subthemes revealed that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. The partner's role is depicted as consultative and mostly supportive. CONCLUSION These results provide new insights on the involvement of the partner in decision-making. Thus, it now seems crucial to develop a prospective study, which will help understand the progression of the decision-making process over time. Statement of contribution What is already known on this subject? Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. Shared decision-making between patients and physicians is now the 'gold standard' in Western Europe and the United States. However, in the context of breast reconstruction (BR) after cancer, factors guiding the decision-making process for BR, especially the potential involvement of the partner, are not very well understood. What does this study add? Provides a qualitative insight on the specific nature of heterosexual couples' representations regarding the decision-making process for breast reconstruction after cancer. Reveals that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. Underlines the consultative function of partners with women engaged in breast reconstruction.
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Affiliation(s)
- Léonor Fasse
- LPPM EA 4452, University of Burgundy, Dijon, France.,Gustave Roussy Hospital, Psycho-Oncology Unit, Villejuif, France
| | - Cécile Flahault
- LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France
| | | | | | - Anna Van Wersch
- School of Social Sciences & Law, Social Futures Institute, Teesside University, Middlesbrough, UK
| | - Bruno Quintard
- INSERM U1219 'Bordeaux Population Health Research Center' Team 'Psycho-epidemiology of Aging & Chronic Diseases', University of Bordeaux, France
| | - Aurélie Untas
- LPPS EA 4057, University Paris Descartes, IUPDP, Paris, France
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