1
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Zhao J, Xiao C. Oncologic Safety of One-Stage Implant-Based Breast Reconstruction in Breast Cancer Patients With Positive Sentinel Lymph Nodes: A Single-Center Retrospective Study Using Propensity Score Matching. Clin Breast Cancer 2024; 24:e1-e8. [PMID: 37775348 DOI: 10.1016/j.clbc.2023.09.007] [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: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the oncologic safety of one-stage implant-based breast reconstruction (OIBR) following mastectomy in breast cancer patients with positive sentinel lymph nodes (SLNs). METHODS We collected clinical and pathological data from breast cancer patients with positive SLNs who underwent OIBR or not after mastectomy between January 2015 and December 2018. A total of 194 patients were included, with 130 patients undergoing mastectomy alone (MA) and 64 patients receiving OIBR after mastectomy. The clinical and pathological features, as well as the postoperative oncologic outcomes, of the 2 groups were retrospectively analyzed. Propensity score matching (PSM) was employed to mitigate the effects of data bias and confounding factors. RESULTS The median follow-up time was 66 months for the OIBR group and 64 months for the MA group after PSM. The majority of reconstructive surgeries use an approach of prosthetic implantation (52.0%). This is followed by prosthetic implantation combined with a latissimus dorsi (LD) flap (32.0%), and acellular dermal matrix (ADM)-assisted implant placement (16.0%). During the follow-up period, a local recurrence was observed in 1 case, regional recurrence in 3 cases, and distant metastasis leading to death in 3 cases among the OIBR group patients. No significant difference was found between the OIBR and MA groups in disease-free survival (DFS) (P = .66), distant metastasis-free survival (DMFS) (P = .91), locoregional recurrence-free survival (LRRFS) (P = .44), and overall survival (OS) (P = .57). CONCLUSION OIBR is a safe option for breast cancer patients with positive SLNs and does not negatively impact cancer recurrence or overall survival.
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Affiliation(s)
- Jingjing Zhao
- The First Department of Breast Cancer, Tianjin Medical University, Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Chunhua Xiao
- The First Department of Breast Cancer, Tianjin Medical University, Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
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2
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Or Z, Rococco E, Touré M, Bonastre J. Impact of Competition Versus Centralisation of Hospital Care on Process Quality: A Multilevel Analysis of Breast Cancer Surgery in France. Int J Health Policy Manag 2022; 11:459-469. [PMID: 33008262 PMCID: PMC9309946 DOI: 10.34172/ijhpm.2020.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/13/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The implications of competition among hospitals on care quality have been the subject of considerable debate. On one hand, economic theory suggests that when prices are regulated, quality will be increased in competitive markets. On the other hand, hospital mergers have been justified by the need to exploit cost advantages, and by evidence that hospital volume and care quality are related. METHODS Based on patient-level data from two years (2005 and 2012) we track changes in market competition and treatment patterns in breast cancer surgery. We focus on technology adoption as a proxy of process quality and examine the likelihood of offering two innovative surgical procedures: immediate breast reconstruction (IBR), after mastectomy and sentinel lymph node biopsy (SLNB). We use an index of competition based on a multinomial logit model of hospital choice which is not subject to endogeneity bias, and estimate its impact on the propensity to receive IBR and SLNB by means of multilevel models taking into account both observable patient and hospital characteristics. RESULTS The likelihood of receiving these procedures is significantly higher in hospitals located in more competitive markets. Yet, hospital volume remains a significant indicator of quality, therefore benefits of competition appear to be sensitive to the estimates of the impact of volume on care process. In France, the centralisation policy, with minimum activity thresholds, have contributed to improving breast cancer treatment between 2005 and 2012. CONCLUSION Finding the right balance between costs and benefits of market competition versus concentration of hospital care supply is complex. We find that close to monopolistic markets do not encourage innovation and quality in cancer treatment, but highly competitive markets where many hospitals have very low activity volumes are also problematic because hospital quality is positively linked to patient volume.
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Affiliation(s)
- Zeynep Or
- IRDES, Institut de Recherche et documentation en Economie de la Santé, Paris, France
| | - Emeline Rococco
- Institut Gustave Roussy, Biostatistical and Epidemiological Division, Paris, France
| | - Mariama Touré
- IRDES, Institut de Recherche et documentation en Economie de la Santé, Paris, France
| | - Julia Bonastre
- Department of Biostatistics and Epidemiology, Institut Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat (CESP U1018 INSERM), Labeled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
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3
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Russell T. Women who undergo mastectomy for breast cancer are now offered reconstruction in line with national guidelines but the majority decline: A UK teaching hospital experience. Breast Dis 2021; 40:69-73. [PMID: 33523033 DOI: 10.3233/bd-201047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to evaluate what proportion of breast cancer patients were offered reconstruction following mastectomy (to assess compliance with national guidelines) and to consider the reasoning if patients were not given this option. METHODS Records of all mastectomies were obtained from a prospectively maintained database (September 2018-October 2019). The following were collected: demographics, indication for surgery, tumour properties, and indication for mastectomy over breast-conserving surgery. Clinic letters were used to determine whether patients were offered reconstruction and whether they accepted. If a patient was not offered reconstruction, the rationale for this was recorded. RESULTS 201 mastectomies were carried out on 179 patients. 77.3% of women were offered reconstruction following mastectomy for cancer and 92.9% of women were offered reconstruction following mastectomy for non-invasive disease. Patients were not offered reconstruction only if they had significant co-morbidities (ASA grade III or higher); no patients who expressed an interest in reconstruction were declined. The most common reasons reconstruction was not offered included: deemed too frail following surgeon assessment (29.7%), advanced cancer (16.2%), and deemed high-risk following anaesthetist assessment (16.2%). 59.1% of patients who were offered reconstruction declined. Mean age in those who declined was significantly higher (P > 0.001). CONCLUSIONS Our unit now complies with national guidelines when offering reconstruction to mastectomy patients; this service was not previously offered. Further research into the reasons behind why women are declining reconstruction is necessary to ensure we are providing adequate information in an appropriate format.
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4
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Miles JC, Raja SV. A Response to: The Plastic Surgeon's Role in Health Equity Research and Policy. Ann Plast Surg 2021; 86:609. [PMID: 33443888 DOI: 10.1097/sap.0000000000002663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sunit Vipin Raja
- Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
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5
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Lee RXN, Yogeswaran G, Wilson E, Oni G. Barriers and facilitators to breast reconstruction in ethnic minority women-A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:463-474. [PMID: 33309318 DOI: 10.1016/j.bjps.2020.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Post-mastectomy breast reconstruction (PMBR) is an important component of the multidisciplinary care of breast cancer patients. Despite the improved quality of life, significant racial disparities exist in the receipt of PMBR. Given the increasing population of Black, Asian and minority ethnic (BAME) women in UK, it is important to address this disparity. Our review aims to identify the barriers and facilitators influencing the uptake of PMBR in BAME women and raise awareness for physicians on interventions that could improve uptake of PMBR in BAME women. METHODS The methodology outlined by the Cochrane guidelines was used to structure this systematic review. Systematic searches for qualitative studies on barriers and/or facilitators to PMBR in ethnic women published in English were conducted. The following databases were searched from their inception up to June 2019: MEDLINE, EMBASE, PubMed, Cochrane Library, Google Scholar and Scopus. Reference lists of all included articles and relevant systematic reviews were also hand-searched for possible additional publications. Publication year or status restrictions were not applied. Only full text articles published in English and by peer reviewed journals are included. Exclusion criteria were as follows: quantitative studies on barriers and/or facilitators to PMBR, abstracts, conference proceedings, non-English language and non-specific to BAME women. A thematic synthesis approach was used through the development of sub-themes and themes from the findings of the included qualitative studies. RESULTS Five studies satisfied the inclusion and exclusion criteria. Three overarching themes emerged from our review: physician-associated factors (physician recommendations), patient-associated factors (knowledge, language, community and cultural, emotions, logistics, patient characteristics) and system-associated factors (insurance coverage, income status). CONCLUSION Our systematic review suggests that there is a paucity of data in the literature on the barriers and facilitators to PMBR in BAME women. Considering the expanding population of BAME women and increasing breast cancer incidence, it is imperative that future research in this field is carried out. Physician and patient-associated factors were identified as the most important yet modifiable factors. Adopting a combination of culturally tailored interventions targeting these factors may help improve the access of PMBR in BAME women. REGISTRATION Prospero ID: CRD42019133233.
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Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
| | - Gowsika Yogeswaran
- University of Nottingham, School of Medicine, Nottingham, United Kingdom
| | - Emma Wilson
- University of Nottingham, School of Medicine, Nottingham, United Kingdom
| | - Georgette Oni
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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6
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Karimi N, Descallar J, Girgis A, Soon PS. Breast reconstruction in South Western Sydney. ANZ J Surg 2020; 90:2340-2345. [PMID: 33021080 DOI: 10.1111/ans.16298] [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: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. METHODS The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. RESULTS The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). CONCLUSION This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.
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Affiliation(s)
- Neda Karimi
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Patsy S Soon
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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7
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O'Neill AC. Achieving consistent and equitable access to post mastectomy breast reconstruction. Gland Surg 2020; 9:1082-1085. [PMID: 32953621 DOI: 10.21037/gs.2020.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anne C O'Neill
- Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada
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8
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Wignarajah P, Forouhi P, Malata CM. The past, the present and the future of UK breast reconstruction-are our practices outdated in 2020? Gland Surg 2020; 9:1076-1079. [PMID: 32953619 DOI: 10.21037/gs.2020.02.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Primeera Wignarajah
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK
| | - Charles M Malata
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK.,Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK.,Anglia Ruskin University School of Medicine, Cambridge & Chelmsford, England, UK
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9
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Unukovych D, Gümüscü R, Wärnberg F, de Boniface J, Eriksen C, Sund M, Nåsell P, Åhsberg K, Olofsson P, Lewin R, Lambe M, Brandberg Y, Folkvaljon F, Mani M. Breast reconstruction patterns from a Swedish nation-wide survey. Eur J Surg Oncol 2020; 46:1867-1873. [PMID: 32698944 DOI: 10.1016/j.ejso.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The overall aim of the Swedish Breast Reconstruction Outcome Study was to investigate national long-term outcomes after mastectomy with or without breast reconstruction. The current report evaluates breast reconstruction (BR) patterns in Sweden over time. MATERIALS AND METHODS This is a cross-sectional, registry-based study where all women operated with mastectomy 2000, 2005, 2010 were identified (N = 5853). Geographical differences in type of BR were investigated using heatmaps. Distribution of continuous variables were compared using the Mann-Whitney U test, categorical variables were compared using the chi-square test. RESULTS Mean age at survey was 69 years (SD=±11.4) and response rate was 50%, responders were on average six years younger than the non-responders and had a more favourable tumor stage (both p < 0.01). Of the 2904 responders, 31% (895/2904) had received a BR: implant-based in 58% (516/895)autologous in 31% (281/895). BR was immediate in 20% (176/895) and delayed in 80% (719/895) women. Women with BR were on average one year older, more often had a normal BMI, reported to be married or had a partner, had a higher educational level and a higher annual income when compared to those without BR (all p < 0.001). The independent factors of not receiving BR were older age and given radiotherapy. CONCLUSIONS To our knowledge, this is the first national long-term follow-up study on women undergoing mastectomy with and without BR. Around 30% of the survey responders have had a BR with a significant geographical variation highlighting the importance of information, availability and standardisation of indications for BR.
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Affiliation(s)
- Dmytro Unukovych
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden; Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Rojda Gümüscü
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Sweden
| | - Jana de Boniface
- Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Eriksen
- Department of Clinical Science and Education, Southern General Hospital, Stockholm, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Petra Nåsell
- Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Kristina Åhsberg
- Department of Breast and Melanoma Surgery, Skåne University Hospital, Malmö Lund, Sweden
| | - Pia Olofsson
- Department of Hand Surgery and Plastic Surgery, Linköping University Hospital, Linköping, Sweden
| | - Richard Lewin
- Department of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska Akademin, Gothenburg, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Folke Folkvaljon
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
| | - Maria Mani
- Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden
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10
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Hart SE, Momoh AO. Breast Reconstruction Disparities in the United States and Internationally. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00366-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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11
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Allan J, Locke M, Wagener J. Ethnic variability in
post‐mastectomy
breast reconstruction in Counties Manukau District Health Board in 2017: a retrospective review. ANZ J Surg 2020; 90:1402-1407. [DOI: 10.1111/ans.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Allan
- Faculty of Medicine and Health ScienceThe University of Auckland Auckland New Zealand
| | - Michelle Locke
- Faculty of Medicine and Health ScienceThe University of Auckland Auckland New Zealand
- Department of Plastic and Reconstructive SurgeryMiddlemore Hospital Auckland New Zealand
| | - Jenny Wagener
- Department of General SurgeryMiddlemore Hospital Auckland New Zealand
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12
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Mahoney B, Walklet E, Bradley E, Thrush S, Skillman J, Whisker L, Barnes N, Holcombe C, Potter S. Experiences of implant loss after immediate implant-based breast reconstruction: qualitative study. BJS Open 2020; 4:380-390. [PMID: 32181587 PMCID: PMC7260419 DOI: 10.1002/bjs5.50275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/06/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Immediate implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK, but almost one in ten women experience implant loss and reconstructive failure after this technique. Little is known about how implant loss impacts on patients' quality of life. The first phase of the Loss of implant Breast Reconstruction (LiBRA) study aimed to use qualitative methods to explore women's experiences of implant loss and develop recommendations to improve care. METHODS Semistructured interviews were conducted with a purposive sample of women who experienced implant loss after immediate IBBR, performed for malignancy or risk reduction across six centres. Interviews explored decision-making regarding IBBR, and experiences of implant loss and support received. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved. RESULTS Twenty-four women were interviewed; 19 had surgery for malignancy and five for risk reduction. The median time between implant loss and interview was 42 (range 22-74) months. Ten women had undergone secondary reconstruction, two were awaiting surgery, and 12 had declined further reconstruction. Three key themes were identified: the need for accurate information about the risks and benefits of IBBR; the need for more information about 'early-warning' signs of postoperative problems, to empower women to seek help; and better support following implant loss. CONCLUSION Implant loss is a devastating event for many women. Better preoperative information and support, along with holistic patient-centred care when complications occur, may significantly improve the experience and outcome of care.
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Affiliation(s)
- B. Mahoney
- School of Psychology, College of Business, Psychology and SportUniversity of WorcesterWorcesterUK
| | - E. Walklet
- School of Psychology, College of Business, Psychology and SportUniversity of WorcesterWorcesterUK
| | - E. Bradley
- College of Health, Life and Environmental SciencesUniversity of WorcesterWorcesterUK
| | - S. Thrush
- Breast UnitWorcester Royal HospitalWorcesterUK
| | - J. Skillman
- Department of Plastic SurgeryUniversity Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge RoadCoventryUK
| | - L. Whisker
- Nottingham Breast InstituteCity HospitalNottinghamUK
| | - N. Barnes
- Nightingale Breast UnitManchester University NHS Foundation TrustManchesterUK
| | - C. Holcombe
- Linda McCartney CentreRoyal Liverpool and Broadgreen University HospitalLiverpoolUK
| | - S. Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical SchoolBristolUK
- Bristol Breast Care Centre, North Bristol NHS TrustSouthmead HospitalBristolUK
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13
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Jeevan R. Reconstructive utilisation and outcomes following mastectomy surgery in women with breast cancer treated in England. Ann R Coll Surg Engl 2020; 102:110-114. [PMID: 31418290 PMCID: PMC6996420 DOI: 10.1308/rcsann.2019.0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Breast cancer usually necessitates breast-conserving surgery or mastectomy, which adversely affect appearance and wellbeing. Immediate reconstruction restores the breast mound but its availability and efficacy are uncertain. MATERIALS AND METHODS Two discrete datasets were used to evaluate mastectomies in England: Hospital Episode Statistics to measure overall activity and variation over time and by region and a national prospective audit to evaluate immediate reconstruction decision making, complication rates and patient-reported satisfaction with information, choice and outcomes. RESULTS The 2005-08 Hospital Episode Statistics analyses identified 20% breast-conserving surgery reoperation rates nationally, frequently involving mastectomy. Rates were higher with in-situ disease present (30% vs 18%) and varied across NHS trusts (10th-90th centiles 12-30%). The 2008-09 national audit examined 18,216 women. The 19% immediate reconstruction rate varied regionally (9-43%), as did 2006-09 Hospital Episode Statistics data (8-32%). A total of 48% of women were offered immediate reconstruction, again varying regionally (24-75%). Offer likelihood fell with increasing age. National immediate reconstruction rates increased from 10% to 23% from 2000 to 2014, but regional variation persisted. Despite high care satisfaction, just 65% of mastectomy patients received the right amount of reconstructive information (90% for immediate reconstruction). Women from deprived areas experienced higher complication rates. Flap-based immediate reconstruction led to greater satisfaction with breast area appearance, emotional and sexual wellbeing and overall outcome than mastectomy; implant-only immediate reconstruction scored no better. CONCLUSION Reconstruction is central to improving breast cancer outcomes. The differential outcomes and persistent regional inequalities identified should facilitate decision making, support improved access to all reconstructive options and inform the development of an optimal patient pathway.
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Affiliation(s)
- R Jeevan
- Honorary Research Fellow, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Consultant Plastic Surgeon, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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14
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Feng Y, Flitcroft K, van Leeuwen MT, Elshaug AG, Spillane A, Pearson SA. Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ J Surg 2019; 89:1230-1235. [PMID: 31418524 PMCID: PMC6852512 DOI: 10.1111/ans.15381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
Background The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries. Methods We used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR. Results We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals. Conclusion Wide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.
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Affiliation(s)
- Yingyu Feng
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Flitcroft
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia
| | - Marina T van Leeuwen
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Breast and Surgical Oncology, The Poche Centre, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Units, The Mater Hospital, Sydney, New South Wales, Australia.,Breast and Melanoma Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Menzies Centre for Health Policy, Sydney School of Public Health, Charles Perkins Centre D17, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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15
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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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16
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O'Halloran N, Lowery A, Kalinina O, Sweeney K, Malone C, McLoughlin R, Kelly J, Hussey A, Kerin M. Trends in breast reconstruction practices in a specialized breast tertiary referral centre. BJS Open 2017; 1:148-157. [PMID: 29951617 PMCID: PMC5989961 DOI: 10.1002/bjs5.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Breast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population. METHODS Data were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy. RESULTS Of 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early-stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy. CONCLUSION Breast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant-based approaches.
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Affiliation(s)
- N. O'Halloran
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - A. Lowery
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - O. Kalinina
- Department of MathematicsNational University of Ireland GalwayGalwayIreland
| | - K. Sweeney
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - C. Malone
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - R. McLoughlin
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - J. Kelly
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - A. Hussey
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - M. Kerin
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
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17
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Tarkowski R, Szmigiel K, Rubin A, Borowiec G, Szelachowska J, Jagodziński W, Bębenek M. Patient's Education Before Mastectomy Influences the Rate of Reconstructive Surgery. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:537-542. [PMID: 26792785 PMCID: PMC5543184 DOI: 10.1007/s13187-016-0982-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Breast reconstruction (BR) should be offered and discussed to each woman with breast cancer who planned for mastectomy, except the cases with severe comorbidities. However, the majority of these patients do not undergo reconstructive surgery. A 20-question survey was administered to a group of 50 women (age 29-83 years, median 53) treated with mastectomy. 22.4 % underwent reconstruction of the breast, 24.5 % declared an interest in BR in the future, 53.1 % were not interested in reconstructive surgery. 51.2 % obtained information concerning BR before surgery, 58.1 % after and 44.2 % both before and after mastectomy. 59.2 % were informed about reimbursement. Information given before surgery had a statistically significant impact on performing reconstruction or a declared interest in BR (X 2 = 4.950, df = 1, p < 0.05), as well as information about reimbursement (X 2 = 8.875, df = 1, p < 0.05). Age <55 years was another significant factor (X 2 = 13.522, df = 1, p < 0.05, C Pearson = 0.525). Level of education did not impact upon the choice (p > 0.05). The main reasons for the refusal were fear of complications (47.4 %), priority to recovery over aesthetic (36.8 %), age, defined by the patient as "advanced" (31.6 %), high level of acceptance of the body after amputation (31.6 %), fear of cancer recurrence (26.3 %) and fear of the pain and discomfort (15.8 %). Each patient who planned for mastectomy should obtain sufficient information regarding breast reconstruction. Exact information is of special benefit to women discouraged by imagined disadvantages of surgery. Patients' education impacts the quality of life-not only before surgery but also lifelong after finishing the treatment.
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Affiliation(s)
- R Tarkowski
- Department of Oncology, Division of Surgical Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland.
- 1st Department of Surgical Oncology, Lower Silesian Comprehensive Cancer Center, pl. Hirszfelda 12, 53-413, Wroclaw, Poland.
| | - K Szmigiel
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - A Rubin
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - G Borowiec
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - J Szelachowska
- Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 53-413, Wroclaw, Poland
| | - W Jagodziński
- Analiza Badania Rozwój, Osiedle Stefana Batorego 11 lok 74, 60-687, Poznan, Poland
| | - M Bębenek
- 1st Department of Surgical Oncology, Lower Silesian Comprehensive Cancer Center, pl. Hirszfelda 12, 53-413, Wroclaw, Poland
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18
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Sim N, Soh S, Ang CH, Hing CH, Lee HJ, Nallathamby V, Yap YL, Ong WC, Lim TC, Lim J. Breast reconstruction rate and profile in a Singapore patient population: a National University Hospital experience. Singapore Med J 2017; 59:300-304. [PMID: 28503698 DOI: 10.11622/smedj.2017035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Breast reconstruction is an integral part of breast cancer management with the aim of restoring a breast to its natural form. There is increasing awareness among women that it is a safe procedure and its benefits extend beyond aesthetics. Our aim was to establish the rate of breast reconstruction and provide an overview of the patients who underwent breast reconstruction at National University Hospital (NUH), Singapore. METHODS We evaluated factors that impact a patient's decision to proceed with breast reconstruction, such as ethnicity, age, time and type of implant. We retrospectively reviewed the medical records of women who had breast cancer and underwent breast surgery at NUH between 2001 and 2010. RESULTS The breast reconstruction rate in this study was 24.3%. There were 241 patients who underwent breast reconstruction surgeries (including delayed and immediate procedures) among 993 patients for whom mastectomies were done for breast cancer. Chinese patients were the largest ethnic group who underwent breast reconstruction after mastectomy (74.3%). Within a single ethnic patient group, Malay women had the largest proportion of women undergoing breast reconstruction (60.0%). The youngest woman in whom cancer was detected in our study was aged 20 years. Malay women showed the greatest preference for autologous tissue breast reconstruction (92.3%). The median age at cancer diagnosis of our cohort was 46 years. CONCLUSION We noted increases in the age of patients undergoing breast reconstruction and the proportion of breast reconstruction cases over the ten-year study period.
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Affiliation(s)
- Nadia Sim
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sharon Soh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuan Han Ang
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Chor Hoong Hing
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Surgery, National University Health System, Singapore
| | - Han Jing Lee
- Department of Surgery, National University Health System, Singapore.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Vigneswaran Nallathamby
- Department of Surgery, National University Health System, Singapore.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Yan Lin Yap
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Wei Chen Ong
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Thiam Chye Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
| | - Jane Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore
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19
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Mennie JC, Mohanna PN, O'Donoghue JM, Rainsbury R, Cromwell DA. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study. Eur J Surg Oncol 2016; 43:52-61. [PMID: 27776942 DOI: 10.1016/j.ejso.2016.09.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Little is known about post-mastectomy reconstruction procedural trends in women diagnosed with breast cancer in England. Our aim was to examine patterns of immediate and delayed reconstruction procedures over time and within regions. METHODS Women with breast cancer who underwent unilateral index immediate or delayed post-mastectomy reconstruction between 2007 and 2014 were identified using the National Hospital Episode Statistics database. Women were grouped into categories based on the type of reconstruction procedure. Adjusted rates of implant and free flap reconstructions were then calculated across regional Cancer Networks using a regression model to adjust for age, disease, comorbidities, ethnicity, and deprivation. RESULTS Between 2007 and 2014, 21 862 women underwent immediate reconstruction and 8653 delayed reconstruction. Immediate implant reconstruction increased from 30% to 54%, and immediate free flap reconstruction from 17% to 21%. Adjusted immediate implant and free flap proportions ranged from 17 to 68% and 9-63%, respectively, across regions. Free flaps became more common in the delayed setting, rising from 25% to 42%. However, adjusted rates ranged from 23% to 74% across regions. Networks with high/low rates of free flaps for immediate tended to have high/low rates for delayed reconstruction. CONCLUSION There has been a substantial increase in the use of immediate implant reconstruction in England. In comparison, there has been an increasing use of autologous free flap reconstruction for delayed procedures. Significant regional variation exists in the type of reconstruction performed, and these patterns need to be examined to determine if variation is related to service provision and/or capacity barriers.
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Affiliation(s)
- J C Mennie
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK; Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - P-N Mohanna
- Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - J M O'Donoghue
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK
| | - R Rainsbury
- Department of Breast Surgery, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Road, Winchester, SO22 5DG, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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20
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Dave R, O'Connell R, Rattay T, Tolkien Z, Barnes N, Skillman J, Williamson P, Conroy E, Gardiner M, Harnett A, O'Brien C, Blazeby J, Potter S, Holcombe C. The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy. BMJ Open 2016; 6:e012678. [PMID: 27855106 PMCID: PMC5073644 DOI: 10.1136/bmjopen-2016-012678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy. METHODS AND ANALYSIS Breast and plastic surgery centres in the UK performing mastectomy with or without (±) IBR will be invited to participate in the study through the trainee research collaborative network. All women undergoing mastectomy ± IBR for breast cancer between 1 July and 31 December 2016 will be included. Patient demographics, operative, oncological and complication data will be collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR will be compared to determine the impact that IBR has on the time of delivery of adjuvant therapy. Prospective data on 3000 patients from ∼50 centres are anticipated. ETHICS AND DISSEMINATION Research ethics approval is not required for this study. This has been confirmed using the online Health Research Authority decision tool. This novel study will explore whether IBR impacts the time to delivery of adjuvant therapy. The study will provide valuable information to help patients and surgeons make more informed decisions about their surgical options. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative (MFAC) and the Reconstructive Surgery Trials Network (RSTN), the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Participating units will have access to their own data and collective results will be presented at relevant surgical conferences and published in appropriate peer-reviewed journals.
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Affiliation(s)
- Rajiv Dave
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester, UK
| | - Zoe Tolkien
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicola Barnes
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Paula Williamson
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Elizabeth Conroy
- Department of Biostatistics, Clinical Trials Research Centre, University of Liverpool MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Jane Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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21
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Archer S, Holland FG, Montague J. 'Do you mean I'm not whole?': Exploring the role of support in women's experiences of mastectomy without reconstruction. J Health Psychol 2016; 23:1598-1609. [PMID: 27596275 DOI: 10.1177/1359105316664135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explores the role of others in supporting younger women who opt not to reconstruct their breast post-mastectomy. Semi-structured interviews were conducted with six women diagnosed with breast cancer in their 30s/40s. The women lived in England, had been diagnosed a minimum of 5 years previously and had undergone unilateral mastectomy. An interpretative phenomenological analysis revealed three themes: Assuring the self: 'I'll love you whatever', Challenging the self: 'Do you mean I'm not whole?' and Accepting the self: 'I've come out the other side'. The women's experiences of positive support and challenges to their sense of self are discussed.
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22
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Jeevan R, Mennie JC, Mohanna PN, O'Donoghue JM, Rainsbury RM, Cromwell DA. National trends and regional variation in immediate breast reconstruction rates. Br J Surg 2016; 103:1147-56. [PMID: 27324317 DOI: 10.1002/bjs.10161] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/18/2015] [Accepted: 02/16/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have identified variation in immediate reconstruction (IR) rates following mastectomy for breast cancer across English regions during a period of service reorganization, a national audit and changing guidelines. This study analysed current variations in regional rates of IR in England. METHODS Patient-level data from Hospital Episode Statistics were used to define a cohort of women who underwent primary mastectomy for invasive or in situ breast carcinoma in English National Health Service (NHS) hospitals between April 2000 and March 2014. A time series of IR rates was calculated nationally and within regions in 28 cancer networks. Regional IR rates before and after the national audit were compared, using logistic regression to adjust for patient demographics, tumour type, co-morbidity and year of mastectomy. RESULTS Between 2000 and 2014, a total of 167 343 women had a mastectomy. The national IR rate was stable at around 10 per cent until 2005; it then increased to 23·3 per cent by 2013-2014. Preaudit (before January 2008), adjusted cancer network-level IR rates ranged from 4·3 to 22·6 per cent. Postaudit (after April 2009) adjusted IR rates ranged from 13·1 to 36·7 per cent, with 20 networks having IR rates between 15 and 24 per cent. The degree of change was not greatest amongst those that started with the lowest IR rates, with four networks with the largest absolute increase also starting with relatively high IR rates. CONCLUSION The national IR rate increased throughout the study period. Substantial regional variation remains, although considerable time has elapsed since a period of service reorganization, guideline revision and a national audit.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - J C Mennie
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P N Mohanna
- Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M O'Donoghue
- Plastic and Reconstructive Surgery Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R M Rainsbury
- Department of Breast Surgery, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury R, Cromwell DA. The Proportion of Women Who Have a Breast 4 Years after Breast Cancer Surgery: A Population-Based Cohort Study. PLoS One 2016; 11:e0153704. [PMID: 27148870 PMCID: PMC4858207 DOI: 10.1371/journal.pone.0153704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/03/2016] [Indexed: 11/19/2022] Open
Abstract
Background There are numerous pathways in breast cancer treatment, many of which enable women to retain a breast after treatment. We evaluated the proportion of women who have a breast, either through conserving surgery (BCS) or reconstruction, at 4-years after diagnosis, and how this varied by patient group. Methods and Findings We identified women with breast cancer who underwent initial BCS or mastectomy in English National Health Service (NHS) hospitals between January 2008 and December 2009 using the Hospital Episode Statistics (HES) database. Women were assigned into one of four patient groups depending on their age at diagnosis and presence of comorbidities. The series of breast cancer procedure (BCS, mastectomy, immediate, or delayed reconstruction) undergone by each women was identified over four years, and the proportion of women with a breast calculated. Variation was examined across patient groups, and English Cancer Networks. Between 2008 and 2009, 60,959 women underwent BCS or mastectomy. The proportion with a breast at 4 years was 79.3%, and 64.0%, in women less than 70 years without, and with comorbidities. Whilst in women aged 70 and over without, and with comorbidities, proportions were 52.6%, and 38.2%, respectively. Comorbidities were associated with lower proportions of BCS, but had little effect on reconstruction rates unlike age. Networks variation of 15% or more was found within each patient group, and Cancer Networks tended to have either a high or low proportion across all four patient groups. However, while 14% of women under 70 years had undergone reconstruction, less than 2% of women aged 70 or more had this treatment option. Conclusion The proportion of women diagnosed with breast cancer who retain a breast at 4 years is strongly associated with age, and presence of comorbidities. There was significant variation between Cancer Networks indicating that women’s experience in England was dependent on their geographical location of treatment.
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Affiliation(s)
- Joanna C. Mennie
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Joseph M O’Donoghue
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Richard Rainsbury
- Department of Breast Surgery, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, United Kingdom
| | - David A. Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Oh D, Flitcroft K, Brennan M, Spillane A. Patterns and outcomes of breast reconstruction in older women – A systematic review of the literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:604-15. [DOI: 10.1016/j.ejso.2016.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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Platt J, Zhong T, Moineddin R, Booth GL, Easson AM, Fernandes K, Gozdyra P, Baxter NN. Geographic Variation Immediate and Delayed Breast Reconstruction Utilization in Ontario, Canada and Plastic Surgeon Availability: A Population-Based Observational Study. World J Surg 2016; 39:1909-21. [PMID: 25896900 DOI: 10.1007/s00268-015-3060-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Utilization of breast reconstruction (BR) is low in many jurisdictions. We studied the geographical and surgical workforce factors that contribute to access and use of BR using a small area analysis approach with a geographical unit of analysis. METHODS We linked administrative data from Ontario Canada to calculate the age-standardized rates for immediate BR (IBR) (same time as mastectomy) between 2002 and 2011, and delayed BR (DBR) (within 3 years of mastectomy) for each county. The influence of plastic surgeon access on variation in county rates of BR was examined using Poisson random effects models. RESULTS 12,663 women underwent mastectomy in Ontario; 2,948 had BR within 3 years (23.3%). Over 50% of the counties had no access to any plastic surgeon. County IBR rates ranged from 0 to 21.5%; plastic surgeon access explained 46% of geographic variation (p<0.0001). IBR rates in counties with very low, low, and moderate access to plastic surgeons were significantly less than counties with high access (relative rate [RR] 0.48 [95% confidence interval (CI) 0.35-0.66], RR 0.61 [CI 0.43-0.87] and RR 0.70 [CI 0.52-0.96], respectively) after adjusting for age and county socioeconomic characteristics. For DBR, while there was less geographic variation, very low access counties demonstrated reduced rates (RR 0.60 [CI 0.47-0.76]). INTERPRETATION Geographic access to a plastic surgeon is a major determinant of BR. Targeted interventions for regions without high access to plastic surgeons may improve overall rates and reduce geographic disparities in care, particularly for IBR.
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Affiliation(s)
- Jennica Platt
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Canada,
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Rococo E, Mazouni C, Or Z, Mobillion V, Koon Sun Pat M, Bonastre J. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics. Eur J Surg Oncol 2016; 42:51-8. [DOI: 10.1016/j.ejso.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
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Awan BA, Samargandi OA, Alghamdi HA, Sayegh AA, Hakeem YJ, Merdad L, Merdad AA. The desire to utilize postmastectomy breast reconstruction in Saudi Arabian women. Predictors and barriers. Saudi Med J 2015; 36:304-9. [PMID: 25737172 PMCID: PMC4381014 DOI: 10.15537/smj.2015.3.10688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To study factors that influence the desire to utilize breast reconstruction after mastectomy, and to investigate the barriers to reconstruction among women in Saudi Arabia. Methods: We conducted a cross-sectional study at 2 surgical centers in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to all breast cancer patients attending the surgery clinics for follow-up after mastectomy between January and March 2013. Ninety-one patients met the study inclusion criteria. The first part of the questionnaire covered the demographic and socioeconomic information regarding factors that might influence the desire to utilize breast reconstruction including possible barriers. Multivariate logistic regression was used to determine the significant predictors of the desire to undergo reconstruction. Results: Overall, 16.5% of patients underwent breast reconstruction after mastectomy. Young age and high educational attainment were significantly associated with an increased desire to undergo reconstruction. The main barriers to reconstruction were the lack of adequate information on the procedure (63%), concerns on the complications of the procedure (68%), and concerns on the reconstruction interfering with the detection of recurrence (54%). Conclusion: Age and educational level were significant predictors of the desire to utilize breast reconstruction. Furthermore, modifiable barriers included the lack of knowledge and misconceptions on the procedure. Addressing these issues may increase the rate of breast reconstruction in Saudi Arabia.
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Affiliation(s)
- Basim A Awan
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Bodilsen A, Christensen S, Christiansen P, Damsgaard TE, Zachariae R, Jensen AB. Socio-demographic, clinical, and health-related factors associated with breast reconstruction – A nationwide cohort study. Breast 2015; 24:560-7. [DOI: 10.1016/j.breast.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/27/2015] [Accepted: 05/03/2015] [Indexed: 11/26/2022] Open
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Jeevan R, Browne JP, Pereira J, Caddy CM, Sheppard C, van der Meulen JHP, Cromwell DA. Socioeconomic deprivation and inpatient complication rates following mastectomy and breast reconstruction surgery. Br J Surg 2015; 102:1064-70. [PMID: 26075654 DOI: 10.1002/bjs.9847] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/13/2015] [Accepted: 04/07/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic deprivation is known to influence the presentation of patients with breast cancer and their subsequent treatments, but its relationship with surgical outcomes has not been investigated. A national prospective cohort study was undertaken to examine the effect of deprivation on the outcomes of mastectomy with or without immediate breast reconstruction. METHODS Data were collected on patient case mix, operative procedures and inpatient complications following mastectomy with or without immediate breast reconstruction in the English National Health Service between 1 January 2008 and 31 March 2009. Multivariable logistic regression was used to examine the relationship between patients' level of (regional) deprivation and the likelihood of local (mastectomy site, flap, flap donor and implant) and distant or systemic complications, after adjusting for potential confounding factors. RESULTS Of 13,689 patients who had a mastectomy, 2849 (20.8 per cent) underwent immediate reconstruction. In total, 1819 women (13.3 per cent) experienced inpatient complications. The proportion with complications increased from 11.2 per cent among the least deprived quintile (Q1) to 16.1 per cent in the most deprived (Q5). Complication rates were higher among smokers, the obese and those with poorer performance status, but were not affected by age, tumour type or Nottingham Prognostic Index. Adjustment for patient-related factors only marginally reduced the association between deprivation and complication incidence, to 11.4 per cent in Q1 and 15.4 per cent in Q5. Further adjustment for length of hospital stay, hospital case volume and immediate reconstruction rate had minimal effect. CONCLUSION Rates of postoperative complications after mastectomy and breast reconstruction surgery were higher among women from more deprived backgrounds.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - J P Browne
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - J Pereira
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK.,University of East Anglia, Norwich Research Park, Norwich, UK
| | - C M Caddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - C Sheppard
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - J H P van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort. Plast Reconstr Surg 2015; 135:468e-476e. [PMID: 25719710 DOI: 10.1097/prs.0000000000001054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study compared overall and breast cancer-specific survival using long-term follow-up data among women diagnosed with invasive breast cancer undergoing mastectomy or breast reconstruction. METHODS Retrospective study using population-based data from Ontario Cancer Registry (1980 to 1990) including women receiving breast reconstruction within 5 years after mastectomy and controls of age- and cancer histology-matched women with mastectomy alone. We compared overall and breast cancer-specific survival using an extended Cox hazards model. Secondary analysis examined conditional survival across early, intermediate, and late follow-up. RESULTS Seven hundred fifty-eight matched pairs formed the cohort, with a median follow-up of 23.4 years (interquartile range, 1.1 to 33.0 years). Fewer breast reconstruction patients died overall or from breast cancer compared with controls (overall survival, 44.5 percent versus 56.7 percent, p < 0.0001; breast cancer-specific survival, 31.8 percent versus 42.6 percent, p = 0.0002, respectively). Breast reconstruction was associated with a 17 percent reduced risk of death and a 19 percent reduced risk of breast cancer death, after adjustment (overall survival hazard ratio, 0.83; 95 percent CI, 0.72 to 0.96; breast cancer-specific survival hazard ratio, 0.81; 95 percent CI, 0.68 to 0.99). Among 885 women (58 percent) surviving 20 or more years, there was no difference in risk of death from breast cancer (hazard ratio, 0.59; 95 percent CI, 0.31 to 1.10). CONCLUSION In a large cohort with invasive breast cancer followed over 20 years, there is no evidence that breast reconstruction is associated with worse survival outcomes compared with mastectomy alone. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Rathinaezhil R, Ugolini F, Osman H. Early experience with implant based breast reconstruction for early breast cancer in ptotic breasts with non biological mesh and lower pole dermal sling. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2015. [DOI: 10.1186/s13022-015-0012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Seneviratne S, Scott N, Lawrenson R, Campbell I. Ethnic, socio-demographic and socio-economic differences in surgical treatment of breast cancer in New Zealand. ANZ J Surg 2015; 87:E32-E39. [DOI: 10.1111/ans.13011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Nina Scott
- Māori Health Services; Waikato District Health Board; Hamilton Waikato New Zealand
| | - Ross Lawrenson
- Waikato Clinical School; University of Auckland; Hamilton Waikato New Zealand
| | - Ian Campbell
- Waikato Clinical School; University of Auckland; Hamilton Waikato New Zealand
- Department of Surgery; Waikato District Health Board; Hamilton Waikato New Zealand
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Winters ZE, Emson M, Griffin C, Mills J, Hopwood P, Bidad N, MacDonald L, Turton EPL, Horne R, Bliss JM. Learning from the QUEST multicentre feasibility randomization trials in breast reconstruction after mastectomy. Br J Surg 2015; 102:45-56. [PMID: 25451179 DOI: 10.1002/bjs.9690] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/08/2014] [Accepted: 09/30/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast reconstruction aims to improve health-related quality of life after mastectomy. However, evidence guiding patients and surgeons in shared decision-making concerning the optimal type or timing of surgery is lacking. METHODS QUEST comprised two parallel feasibility phase III randomized multicentre trials to assess the impact of the type and timing of latissimus dorsi breast reconstruction on health-related quality of life when postmastectomy radiotherapy is unlikely (QUEST A) or highly probable (QUEST B). The primary endpoint for the feasibility phase was the proportion of women who accepted randomization, and it would be considered feasible if patient acceptability rates exceeded 25 per cent of women approached. A companion QUEST Perspectives Study (QPS) of patients (both accepting and declining trial participation) and healthcare professionals assessed trial acceptability. RESULTS The QUEST trials opened in 15 UK centres. After 18 months of recruitment, 17 patients were randomized to QUEST A and eight to QUEST B, with overall acceptance rates of 19 per cent (17 of 88) and 22 per cent (8 of 36) respectively. The QPS recruited 56 patients and 51 healthcare professionals. Patient preference was the predominant reason for declining trial entry, given by 47 (53 per cent) of the 88 patients approached for QUEST A and 22 (61 per cent) of the 36 approached for QUEST B. Both trials closed to recruitment in December 2012, acknowledging the challenges of achieving satisfactory patient accrual. CONCLUSION Despite extensive efforts to overcome recruitment barriers, it was not feasible to reach timely recruitment targets within a feasibility study. Patient preferences for breast reconstruction types and timings were common, rendering patients unwilling to enter the trial.
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Affiliation(s)
- Z E Winters
- Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol Trust, Bristol, UK
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Hartrampf J, Ansmann L, Wesselmann S, Beckmann MW, Pfaff H, Kowalski C. Influence of Patient and Hospital Characteristics on the Performance of Direct Reconstruction after Mastectomy. Geburtshilfe Frauenheilkd 2014; 74:1128-1136. [PMID: 25568467 PMCID: PMC4275316 DOI: 10.1055/s-0034-1383400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
Aim: International studies have shown that the performance of a direct (or immediate) reconstruction (DR) after mastectomy is associated with patient (e.g., socio-economic status, insurance status, age) and hospital (number of cases, teaching status) characteristics. The present article addresses the question if such relationships also exist in Germany. Material and Methods: The results of a nationwide questionnaire to the patients of certified breast cancer centres were coupled with the clinical features of the patients and the characteristics of the hospital. Predictors for receiving a DR (vs. delayed or no reconstruction) were estimated by means of a logistic multilevel model for a sample of 1165 patients from 105 certified locations. Results: Substantial differences between the treating hospitals were found (intraclass correlation coefficient null model: 0.195) which can in part be explained by the total model (total model: 0.169). Patients with the following features are more likely to receive a DR: younger age, private health insurance, secondary school leaving certificate (vs. primary school leaving certificate), lower stage and acquisition of more information about reconstruction. ASA and partnership status are not statistically significantly related with DR. DR is more likely to be performed in hospitals with higher caseload of patients with primary breast cancer. Teaching status, operations per surgeon and urbanity of the location are not related to receiving a DR. Conclusions: Non-clinical features of the patients and the primary case number are associated with the performance of a DR, this poses questions concerning reasons and the equality of health care.
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Affiliation(s)
- J. Hartrampf
- IMVR – Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Universität zu Köln, Köln
| | - L. Ansmann
- IMVR – Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Universität zu Köln, Köln
| | - S. Wesselmann
- Bereich Zertifizierung, Deutsche Krebsgesellschaft, Berlin
| | | | - H. Pfaff
- IMVR – Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Universität zu Köln, Köln
| | - C. Kowalski
- IMVR – Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Universität zu Köln, Köln
- Bereich Zertifizierung, Deutsche Krebsgesellschaft, Berlin
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Simpson JS, Baltzer H, McMillian CR, Boileau JF, Wright F, Lipa J, Snell L, Holloway C. Multidisciplinary assessment for immediate breast reconstruction: A new approach. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jory S. Simpson
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Heather Baltzer
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Catherine R. McMillian
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Jean Francois Boileau
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Frances Wright
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Joan Lipa
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Laura Snell
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Claire Holloway
- Department of Surgery, Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
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Postmastectomy Radiation Therapy after Immediate Two-Stage Tissue Expander/Implant Breast Reconstruction. Plast Reconstr Surg 2014; 134:1e-10e. [DOI: 10.1097/prs.0000000000000292] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeevan R, Cromwell DA, Browne JP, Caddy CM, Pereira J, Sheppard C, Greenaway K, van der Meulen JHP. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthet Surg 2014; 67:1333-44. [PMID: 24908545 DOI: 10.1016/j.bjps.2014.04.022] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/20/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. DESIGN Prospective cohort study. SETTING All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. PARTICIPANTS Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. MAIN OUTCOME MEASURES Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. RESULTS Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p < 0.001). Levels of patient satisfaction with information, choice and the quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. CONCLUSIONS The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction.
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Affiliation(s)
- Ranjeet Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; St. Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside L35 5DR, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - John P Browne
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Christopher M Caddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, 4 Claremont Place, Sheffield S10 2JF, UK
| | - Jerome Pereira
- James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston, Great Yarmouth, Norfolk NR31 6LA, UK; University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - Carmel Sheppard
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, Hampshire PO6 3LY, UK
| | - Kimberley Greenaway
- The Health and Social Care Information Centre, 1 Trevelyan Square, Leeds, West Yorkshire LS1 6AE, UK
| | - Jan H P van der Meulen
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Aggarwal A, Cathcart P, Payne H, Neal D, Rashbass J, Nossiter J, van der Meulen J. The National Prostate Cancer Audit — Introducing a New Generation of Cancer Audit. Clin Oncol (R Coll Radiol) 2014; 26:90-3. [DOI: 10.1016/j.clon.2013.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/09/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Winters ZE, Balta V, Thomson HJ, Brandberg Y, Oberguggenberger A, Sinove Y, Unukovych D, Nava M, Sandelin K, Johansson H, Dobbeleir J, Blondeel P, Bruno N, Catanuto G, Llewellyn-Bennett R. Phase III development of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for women undergoing breast reconstruction. Br J Surg 2014; 101:371-82. [DOI: 10.1002/bjs.9397] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Comprehensive outcome assessments after breast reconstruction (BRR) require surgery-specific patient-reported outcome measures. The aims of this study were to assess the relevance, acceptability and redundancy of questions/items (phase III pretesting) of a new BRR questionnaire evaluating patients' health-related quality of life before and after BRR. Phase III occurred in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) following earlier development phases that identified 31 items.
Methods
The EORTC BRR subgroup applied decision-making rules to each question according to eight EORTC criteria. A total of 197 patients (from the UK, Austria, Belgium, Italy and Sweden) were recruited. Forty-seven patients completed pre- and post-BRR questionnaires prospectively, and 150 reported post-BRR questionnaires only retrospectively. Qualitative debriefing interviews were undertaken in 189 patients. Preliminary psychometric analyses were performed.
Results
Thirty-one items fulfilled ‘relevance’, with none producing ‘difficulties’. Ten items were not a priority for 10 per cent of respondents. Of these, two questions concerning muscle twitching in the affected breast and problem with donor-site swelling were deleted. Three redundant items were deleted: weakness in arm, which correlated significantly to the Quality of Life Questionnaire (QLQ) BR23 breast questionnaire, and shape and colour of the affected nipple. Descriptive statistics reduced the module to 26 items conceptualized into three provisional scales (disease treatment/surgery-related symptoms, sexuality and cosmetic outcome) within the newly completed questionnaire, EORTC QLQ-BRR26.
Conclusion
The QLQ-BRR26 is available for psychometric validation in a large-field international sample. The intended use for QLQ-BRR26 is alongside EORTC QLQ-C30 and QLQ-BR23, in women treated by mastectomy for breast cancer and undergoing all types of BRR.
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Affiliation(s)
- Z E Winters
- School of Clinical Sciences and Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol NHS Trust, Southmead Hospital, Bristol, Sweden
| | - V Balta
- School of Clinical Sciences and Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol NHS Trust, Southmead Hospital, Bristol, Sweden
| | - H J Thomson
- School of Clinical Sciences and Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, School of Clinical Sciences, University of Bristol and North Bristol NHS Trust, Southmead Hospital, Bristol, Sweden
| | - Y Brandberg
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Y Sinove
- Department of Plastic and Reconstructive Surgery Ghent University Hospital, Ghent, Belgium
| | - D Unukovych
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - M Nava
- Instituto Tumori Milano, University of Milan, Milan, Italy
| | - K Sandelin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - H Johansson
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - J Dobbeleir
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - P Blondeel
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - N Bruno
- Plastic Surgery, Instituto Nazionale Tumori, Milan, Italy
| | - G Catanuto
- Plastic Surgery, Instituto Nazionale Tumori, Milan, Italy
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Abstract
BACKGROUND With increasing rates of postmastectomy breast reconstruction, it has been suggested that there is an insufficient supply of services that meet patient demands. This study aimed to identify potential disparities in, and variables associated with, postmastectomy reconstruction in Japan. METHODS Using 20,257 Japanese breast cancer discharge data from 2010, the authors identified 1616 breast cancer patients, with tumor-node-metastasis classification of malignant tumors T1~4 and N0M0, between 20 and 59 years of age. Factors influencing the use of immediate breast reconstruction of either autogenous tissue or tissue expander placement were analyzed using multinomial logistic regression comparing no reconstruction to either autogenous tissue or tissue expander placement. RESULTS The immediate breast reconstruction rate was 11.2 percent among the study patients. The rate of autogenous method use was 49 percent and the rate of tissue expander use was 51 percent. Tissue expander placement was performed primarily in patients who resided in cities (OR, 2.4; 95 percent confidence interval, 1.5 to 4.1) and was performed at city hospitals. Patients who lived in rural areas primarily underwent autogenous tissue reconstruction, traveled to city hospitals to undergo surgery (OR, 2.0; 95 percent confidence interval, 1.0 to 4.0), and had normal body mass index (OR, 1.9; 95 percent confidence interval, 1.1 to 3.1). CONCLUSIONS The authors identified potential disparities associated with breast reconstruction. These disparities might be due to limited surgery methods and might have excluded some patients because of their age, physical, and economic status. Uneven distribution of plastic surgeons might have required patients to travel for breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Exploring inequalities in access to care and the provision of choice to women seeking breast reconstruction surgery: a qualitative study. Br J Cancer 2013; 109:1181-91. [PMID: 23928662 PMCID: PMC3778305 DOI: 10.1038/bjc.2013.461] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/16/2013] [Accepted: 07/21/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Breast reconstruction (BR) may improve psychosocial and cosmetic outcomes after mastectomy for breast cancer but currently, few women opt for surgery. Reasons for this are unclear. The aim of this qualitative study was to explore access to care and the provision of procedure choice to women seeking reconstructive surgery. Methods: Semi-structured interviews with a purposive sample of patients who had undergone BR and professionals providing specialist care explored participants' experiences of information provision before BR. Interviews were transcribed verbatim and analysed using the constant comparative technique of grounded theory. Sampling, data collection and analysis were performed concurrently and iteratively until data saturation was achieved. Results: Both patients and professionals expressed concerns about the provision of adequate procedure choice and access to care. Lack of information and/or time, involvement in decision making and issues relating to the evolution and organisation of reconstructive services, emerged as potential explanations for the inequalities seen. Interventions to improve cross-speciality collaboration were proposed to address these issues. Conclusion: Inequalities in the provision of choice in BR exist, which may be explained by a lack of integration between surgical specialities. Pathway restructuring, service reorganisation and standardisation of training may enhance cross-speciality collaboration and improve the patient experience.
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Héquet D, Zarca K, Dolbeault S, Couturaud B, Ngô C, Fourchotte V, De La Rochefordière A, Féron JG, Fitoussi A, Bélichard C, Reyal F, Laki F, Hajage D, Sigal B, Asselain B, Alran S. Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. SPRINGERPLUS 2013; 2:325. [PMID: 23961399 PMCID: PMC3733069 DOI: 10.1186/2193-1801-2-325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 11/10/2022]
Abstract
Background The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction. Patients and methods We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients. Results The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients. Conclusion Better understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient’s personal needs.
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Semple J, Metcalfe KA, Lynch HT, Kim-Sing C, Senter L, Pal T, Ainsworth P, Lubinski J, Tung N, Eng C, Gilchrist D, Blum J, Neuhausen SL, Singer CF, Ghadirian P, Sun P, Narod SA. International rates of breast reconstruction after prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers. Ann Surg Oncol 2013; 20:3817-22. [PMID: 23740344 DOI: 10.1245/s10434-013-3040-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Breast reconstruction is an option for women with BRCA1 or BRCA2 mutations who elect to undergo prophylactic mastectomy to prevent breast cancer. We report on the uptake of breast reconstruction after prophylactic mastectomy in women with BRCA mutations from eight countries. METHODS Women with a BRCA1 or BRCA2 mutation were questioned regarding their cancer preventive practices. Information was recorded on prophylactic mastectomy and breast reconstruction. RESULTS A total of 1,635 women with a BRCA1 or BRCA2 mutation who elected to undergo prophylactic mastectomy from eight countries were included. A total of 1,137 women (69.5%) had breast reconstruction after prophylactic mastectomy. A total of 58.7% of women over the age of 45 years at the time of prophylactic mastectomy had breast reconstruction compared to 77.6% of women 35 years of age or younger [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.26-0.50, p < 0.001]. In addition, 62.9% of women with a breast cancer diagnosis (contralateral prophylactic mastectomy) had breast reconstruction after prophylactic mastectomy compared to 79.7% of women without a previous breast cancer diagnosis (OR 0.48, 95% CI 0.38-0.61, p < 0.001). A total of 66.9% of women from Canada had breast reconstruction after mastectomy compared to 71.9% of American women (OR 0.75, 95% CI 0.59-0.96, p = 0.02). CONCLUSIONS The majority of women elect for breast reconstruction after prophylactic mastectomy. However, younger women and those without a previous diagnosis of breast cancer are more likely to have breast reconstruction than older women or those with a previous diagnosis of cancer.
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Affiliation(s)
- John Semple
- Women's College Research Institute, Toronto, ON, Canada
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Howard-McNatt MM. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit. BREAST CANCER-TARGETS AND THERAPY 2013; 5:9-15. [PMID: 24648753 DOI: 10.2147/bctt.s29142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms "reconstruction," "mastectomy," "rates," "benefits," and "breast cancer." Breast-reconstruction rates have continued to rise in recent years; however, there are definite barriers to widespread use of this procedure. These barriers include age, ethnicity, income, tumor characteristics, and the need for adjuvant radiation therapy. There are notable psychological advantages to women who receive breast reconstruction. These women also express an improved quality of life. Breast reconstruction is an acceptable technique for women undergoing mastectomy. It should be offered to all women in an immediate or delayed fashion, with guidance from their physician about the benefits and risks.
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Thomson HJ, Winters ZE, Brandberg Y, Didier F, Blazeby JM, Mills J. The early development phases of a European Organisation for Research and Treatment of Cancer (EORTC) module to assess patient reported outcomes (PROs) in women undergoing breast reconstruction. Eur J Cancer 2012; 49:1018-26. [PMID: 23063353 DOI: 10.1016/j.ejca.2012.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A comprehensive evaluation of breast reconstruction (BRR) surgery includes measurement of patient reported outcomes (PROs). There is, however, a lack of validated BRR-specific PRO measures (PROMs) that adequately assess relevant issues. This study is developing a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire/module specific for PROs in BRR to supplement the cancer-core and breast cancer EORTC questionnaires, respectively: the QLQ-C30 and QLQ-BR23. METHODS Phases I and II of questionnaire development followed EORTC guidelines including a systematic literature review to identify all potential 'issues' (concepts relevant to PROs) and semi-structured interviews with 89 patients and 9 European multi-disciplinary health care professionals (HCPs) (Sweden, Italy and the United Kingdom [UK]). Interviewers asked participants the 'relevance' of outcomes identified in the literature and captured additional 'issues' of importance. RESULTS The literature search and interviews of patients and HCPs yielded 69 issues relating to BRR operationalised into 31 provisional items (single questions) for the module, which was conceptualised to contain five scales: treatment/surgery related symptoms (affecting the shoulder, arm and reconstructed breast), body image, sexuality, cosmetic outcomes (pertaining to three areas: breast, donor site and nipple) and overall satisfaction. DISCUSSION The provisional development of the EORTC BRR module has 31 items addressing issues of importance to patients as well as HCPs. Further international testing is underway as a UK National Cancer Research Network trial to ensure that this PROM will be psychometrically and clinically robust and applicable for use in clinical trials, cohort studies, national audit and clinical practice.
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Affiliation(s)
- H J Thomson
- School of Clinical Sciences and Breast Reconstruction Patient Reported and Clinical Outcomes Research Group, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Breast reconstruction: à la carte not table d’hote. Cancer Treat Rev 2012; 38:269-71. [DOI: 10.1016/j.ctrv.2011.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/26/2011] [Accepted: 10/31/2011] [Indexed: 11/21/2022]
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Platt J, Baxter N, Zhong T. Breast reconstruction after mastectomy for breast cancer. CMAJ 2011; 183:2109-16. [PMID: 22065359 DOI: 10.1503/cmaj.110513] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jennica Platt
- Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, and Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
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Barr L. Inequality of access to breast reconstruction. Eur J Surg Oncol 2010; 37:16-7. [PMID: 21074347 DOI: 10.1016/j.ejso.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 10/19/2010] [Indexed: 11/16/2022] Open
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