Background Approximately 40% of women with invasive breast cancer will undergo a mastectomy. Clinical practice guidelines recommend breast reconstruction (BR) options should be discussed with all women who are to undergo a mastectomy. We sought to examine rates of BR, BR methods over time and to identify factors associated with the likelihood of receiving BR in Queensland. Methods This population‐based study used linked data from the Queensland Oncology Repository for 12 364 women who underwent a mastectomy for invasive breast cancer from 2008 to 2017. Multivariate logistic regression was used to model predictors of immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR). Results Overall, 2560 (20.7%) women had BR, with 9.8% having IBR and 10.9% having DBR. Factors associated with a reduced likelihood of IBR or DBR included older age (P < 0.001), living in a regional/rural area (P < 0.001) and having a mastectomy in a public versus private hospital (P < 0.001). Median time from mastectomy to DBR was 18.4 and 29.2 months for women attending a private versus public hospital, respectively (P < 0.001). Use of implant‐based BR increased significantly with a corresponding decrease in autologous BR over time. Conclusions Significant disparities exist in rates of BR between public and private hospitals. Women living in regional and rural areas as well as those aged over 60 years continue to have lower rates of BR. Addressing the health system barriers and developing strategies to improve access to, and uptake of BR should be a priority.
Background The risk of developing colorectal cancer (CRC) increases with increasing age. As surgery is the primary treatment for CRC, our aim was to examine outcomes following major resection for CRC in a cohort of individuals aged ≥65 years. Methods This population‐based retrospective study included 18 339 patients aged ≥65 years diagnosed with CRC from 2007 to 2016. Multivariate logistic regression was used to examine factors associated with the likelihood of having major resection, 30‐day mortality and laparoscopic surgical procedure. Cox proportional hazards was used to examine factors associated with risk of death at 2 years post‐surgery. Results Overall, 77.8% (n = 14 274) of patients had a major resection. Males and patients ≥75 years were significantly less likely to have a major resection (P < 0.001 and P < 0.001, respectively). Thirty‐day mortality was 3.1% and 2‐year overall survival was 78.7%. After adjustment, factors such as increasing age (≥75 years), ≥2 comorbidities, emergency admission, open surgical procedure and treatment in a public hospital were all independently and significantly associated with poorer outcomes. The likelihood a patient had a laparoscopic procedure was significantly lower for those from a disadvantaged area (P < 0.001), emergency admission (P < 0.001) as well as for those treated in a public versus private hospital (P < 0.001). Conclusions Post‐operative mortality increased, and 2‐year survival decreased after age 75 years. The finding of significantly lower rates of laparoscopic surgery for patients from disadvantaged areas and those treated in a public hospital requires further investigation.
BackgroundYouth offenders have high rates of unmet mental health needs, including elevated rates of subclinical or clinical depression. Computerized cognitive behavioral therapy (cCBT) has been shown to be effective for depression, and cognitive behavioral therapy (CBT) is among the most effective psychological treatments for offence related behaviours. We planned to evaluate the impact of SPARX-R 1.0 (the first iteration of a revised version of SPARX cCBT) for adolescents in a community day program (Mentoring Youth New Directions or MYND) for male recidivist youth aged between 14 and 17 years. Recruitment and retention in the trial were lower than anticipated. In this brief report we present main findings and discuss implications.MethodsWe developed a stepwise cohort design to investigate the acceptability and effectiveness of SPARX-R in a complex, real-world setting. Participants were allocated to the MYND program only (treatment as usual), or MYND with the addition of SPARX-R. All adolescents referred to MYND within a specified period were assigned to one of four social workers, as per usual practice. Each social worker was randomized to begin SPARX-R with consenting new clients from one of four time points. Assessments were completed within the first two weeks of commencing the MYND program and then at 10 and 20 weeks after commencement. We solicited brief feedback on SPARX-R from young people and staff who used it.ResultsOf 64 eligible youth who began MYND during the trial period, 51 consented but 25 stopped attending MYND despite court orders or because their court orders were changed. Nineteen participants were randomized to SPARX-R but only two completed two or more levels of the 7-level program, so it was not possible to evaluate the impact as planned. The four participants who provided feedback were indifferent or negative about SPARX-R. Staff advised that technical difficulties (such as loading or saving problems) were off putting and that SPARX-R was slow and not appealing to their clients.ConclusionsComputerized CBT was not successfully implemented in this group, highlighting challenges in retention in this non-residential justice program. The findings also indicate that computerized therapies of proven acceptability and effectiveness in one setting may be unappealing in another. Implementation and equity efforts need to consider and test the specialist needs of diverse groups.
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