Patterns and Correlates of Knowledge, Communication, and Receipt of Breast Reconstruction in a Modern Population-Based Cohort of Patients with Breast Cancer

• Type of Material: Article
• Authors: Adeyiza O. Momoh, University of Michigan; Kent A. Griffith, University of Michigan; Sarah T. Hawley, University of Michigan; Monica Morrow, Memorial Sloan Kettering Cancer Center; Kevin Ward, Emory University; Ann S. Hamilton, University of Southern California; Dean Shumway, University of Michigan; Steven J. Katz, University of Michigan; Reshma Jagsi, University of Michigan
• Language: English
• Date: 2019-08-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by the American Society of Plastic Surgeons.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PRS.0000000000005803
• Title of Journal or Parent Work: Plastic and Reconstructive Surgery
• Volume: 144
• Issue: 2
• Start Page: 303
• End Page: 313
• Grant/Funding Information: Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862–04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California,; This work was funded by grant P01 CA163233 to the University of Michigan from the National Cancer Institute.; The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885;; Contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute.
• Keywords: Science & Technology; Care; Surgery; Decision making; Rates; Psychosocial outcomes; Masectomy; Socioeconomic disparities; Surgeons; Immediate; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: Disparities persist in the receipt of breast reconstruction after mastectomy and little is known about the nature of communication received by patients and potential variations that may exist. Methods: Women with early stage breast cancer (stages 0-II) diagnosed between July 2013 and September 2014 were identified through the Georgia and Los Angeles SEER registries and surveyed to collect additional data on demographics, treatment and decision-making experiences. Treating general/oncologic surgeons were also surveyed. Primary outcomes measures included self-reported communication-related measures on receipt of information on breast reconstruction and on the receipt of breast reconstruction. Results: We analyzed 936 women who underwent mastectomy for unilateral breast cancer. 484 (51.7%) underwent mastectomy with reconstruction. Women who were older and for whom English was not their primary spoken language had lower odds of being informed by a doctor about breast reconstruction. Ultimately, women who were older, were Asian, had invasive disease, had bronchitis/emphysema, and had lower income were less likely to undergo breast reconstruction. Breast reconstruction was performed more often in patients undergoing bilateral mastectomies (OR, 3.27; 95% CI, 2.26–4.75). Women cared for by surgeons with higher volumes of breast cancer patients (51+ patients per year) were more likely to undergo breast reconstruction (OR 2.43, 95% CI 1.40–4.20). Conclusions: To eliminate existing disparities, increased efforts should be made in consultations for surgical management of breast cancer to provide information to all patients regarding the option of breast reconstruction, the possibility of immediate reconstruction, and insurance coverage of all stages of reconstruction.