BACKGROUND: BREAST-Q is a patient-reported outcome (PRO) that has been designed to evaluate perception outcomes among women undergoing different types of breast surgery, the modules include evaluation for mastectomy, breast reconstruction, augmentation, reduction/mastopexy and breast-conserving therapy. OBJECTIVES: Generate a translated version that is conceptually equivalent to the original version and to validate for Mexican population. METHODS: A linguistic and psychometric validation was performed in 494 women. We carry out pre and postoperative test. Reliability and internal consistency were performed by Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: The results of patient testing, number of participants, acceptability and reliability are shown in table 1. The average scores were in all cases >0.80. Summary of BREAST-Q validation analysisN =494Module=nMean age(range)Time to completion Test(minutes) average(range)Time to completion Retest(minutes) average(range)Number of itemsNumber of missing itemsCronbach's Alpha min-max*Test-Retest ICC min-max*Mastectomy=160Pre=6248(26-76)7.8(2-20)6.4(3-20)3700.81-0.940.72-0.94Post=9852(32-78)13(4-40)11(4-28)6310.87-0.970.87-0.96Breast Conserving Therapy=153Pre=8150(21-78)7(2-17)5.2(2-13)3220.88-0.950.82-0.95Post=7255(37-73)18.7(5-44)15.4(6-29)8720.92-0.980.92-0.98Reconstruction=181Pre=6544(23-64)7.9(3-22)6.4(2-20)4220.90-0.970.90-0.97Post=9246(24-74)18.5(8-41)15.7(5-42)11610.86-0.990.85-0.99Lattisimus Dorsi=2445(33-74)5(1-18)4(2-10)1910.95-0.960.96-0.96We report the low and the high value between all sub scales, per questionnaires The internal consistency and reproducibility support the reliability of the instrument; all of the scores were acceptable. DISCUSSION: The importance of measurements quality of life in patient whit cancer, become an essential end-point, we need validated tools that help us improve our performance in different methods of treatments. Is the first validation study of an instrument that measures the impact of surgical treatment on the quality of life of breast cancer patients in Mexico, our results support the equivalent Spanish version for Mexican population. Breast-Q will provide valuable metrics for a surgeon team to document and measure their clinical performance and improve quality of healthcare in our Hispanic patients. CONCLUSIONS: The Mexican Spanish version of tree Modules of Breast-Q is reliable and easy to implement in the population with breast cancer in different scenarios in México with the advantage to measure the quality of life and satisfaction on our population with a locally advanced stage that will help to improve quality of healthcare. The high acceptability of the questionnaire demonstrate that the version is well accepted for our population so we will include a significant number of patient in our country; therefore, more hospital centers will be invited to participate for further studies that allow us to evaluate the population in Latin America and thus compare our results. Citation Format: Bargalló-Rocha J, Gutiérrez-Zacarías L, Gallargo-Alvarado L, Maciel-Miranda J, Shaw-Dulin R, Esparza-Arias N, Figueroa-Padilla J, Vazquez-Romo R, Robles-Vidal C, Drucker-Zertuche M, Cabrera-Galeana P, Cantu-De Leon D. The BREAST-Q: Translation and validation for Mexican population [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-07.
Background Breast cancer represents the most common malignancy in Latin America, and since 2006 it is the cancer type with the highest incidence among Mexican women. Providing multidisciplinary high-quality care for the growing population of patients with breast cancer represents a challenge to low and middle-income countries, which have limited economic resources and limited health staff and facilities. Since 2007, Seguro Popular insurance program has provided coverage for the treatment of women with breast cancer, including surgery, radiotherapy, chemotherapy, endocrine therapy and Her2-targeted treatments; before this program up to 50% of the Mexican population did not have healthcare coverage, and had to pay out of pocket for cancer care. Unfortunately, due to financial constraints, this does not include other interventions which may be relevant, such as supportive care and reconstructive surgery. National Cancer Institute of Mexico (INCan) is a part of the Mexican federal government and as such provides care to uninsured individuals with all types of malignancies, including breast cancer. Since the start of Seguro Popular insurance program (2007), INCan has provided oncological care to over 5,000 women with breast cancer. In 2012, INCan received a grant from the federal government (P017 Reproductive Health and Gender Equality in Health Grant) in order to establish the “Post-Mastectomy Program” (PMP), which aimed providing free patient navigation, supportive care and breast reconstruction for women after mastectomy. Starting on july 2016, derived from PMP, it was possible the setting of a Same-Day Surgery Facility (SDSF) at INCan: two small, fully equipped operation rooms with a small recovery area; and the hiring of 4 nurses and 2 anesthesiologists, adding all this to the one main operation room already set for breast cancer surgery. This allowed an increase in all kind of breast cancer surgery: conservative surgery, mastectomy with sentinel lymph node and breast reconstruction procedures. One of this rooms was assigned to breast reconstructive surgeries. Material and Methods Data were retrospectively collected from a 5 year period, 30 months before SDSF and 30 months after SDSF. Before SDSF an average 66.4 (54-73) of breast reconstruction surgeries were done by six month period, total of 332 breast reconstruction surgeries. After implementation of SDSF an average of 124 (107-138) by six month period, with a total 621 surgeries, which represents an 87% increase in breast reconstruction procedures for the same time period. Conclusion Same day surgery has been proven before to be safe in breast cancer surgery and in breast reconstructive surgery when co-morbidities are accounted for. This work shows that implementation of Same-Day Surgery could be a tool to increase the offer of breast reconstruction in economically restrained systems, in early or experienced breast reconstruction programs in developing economies, and even in developed ones. In our experience, this approach achieved an 87% increase in breast reconstruction procedures, in a 30 month period, which allowed us to benefit more women and offer them a better quality of life. Citation Format: Bargalló-Rocha JE, Gutiérrez-Zacarías LM, Maciel-Miranda A, Figueroa-Padilla J, Drucker-Zertuche M, Esparza-Arias N, Elizalde-Méndez A, Cabrera-Galeana PA. Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-09.
Background In Mexico breast cancer is the leading cause of cancer mortality in women. The goal of reconstruction is restoration of patient's quality of life after cancer, including concerns about body image, sexuality, self-esteem and social life. Reconstruction is one of the most important determinants of long-term health. Autologous reconstruction has been found to offer a better satisfaction in the long term, even these findings, a paradigm shift toward implant reconstruction has been described previously. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together. It takes into account the best clinical evidence available, as well as the patient's values and preferences. In medical treatments where several options have been found, SDM has been a useful tool, increasing patient's satisfaction and better outcomes. Through this process of informing and involving the patient, high-quality decisions that align with patient preferences are achievable. Methods Evaluation of particular case was made, with personalized approach depending on breast cancer stage and mastectomy type planned. On first consultation basic information about different techniques was offered: pros and cons on surgical time, recovery time, long term complications, sensation and physical appearence. We offered a second consultation if the patient wanted to go deeper in the information we presented, or even is she wanted to look out for more information on the internet and other sources. When an abdominal free flap was planned, we saw the patient in a second consultation to review the CT-angio, and to establish the definitive flap option. For risk estimation we used www.brascore.org website, and talk about it with the patient. Then patient and plastic surgeon made decision on breast reconstruction technique. BREAST-Q questionnaries were applied in pre and postoperative setting. Results From 06/2014 to 06/2016 we performed 150 breast reconstructions with this SDM approach with the following techniques: 64% expander, 15% direct to implant, 11% DIEP flap, 6% lattisimus dorsi flap, 3% Becker implant, 1% TRAM flap. BREAST-Q questionnaries showed 100% think breast reconstruction is better than do not reconstruct, and 100% would recommend reconstructive surgery. 91.7% felt included in the decision process. Satisfaction with breast (preoperative vs postoperative) 66.21 vs 81.13, Satisfaction with outcome 85.06, Psychosocial well being 80.75 vs 88.35, Physical well-being 74.92 vs 68.73, Sexual well-being 66.66 vs 72.84, Satisfaction with information 86.86, Satisfaction with surgeon 98.73, Satisfaction with medical staff 96.2. Analysis Implant based reconstruction (82%) was prefered due to: simplicity, less overall risk, and giving more importance to cancer treatment and leaving reconstruction in second place. It could also be a short-term vision regarding benefits, in spite of shared information. Aesthetic improvement of the abdominal area seems to be a factor to decide for autologous abdominal flap among young adult women (7%). Possibility of pregnancy should be considered among young women. In our breast reconstruction program for young women with breast cancer, egg preservation is offered, so abdominal flaps should be delayed after a possible pregnancy. Conclusions We need to encourage SDM in breast reconstruction. We need information systems available to patients prior to breast reconstruction like educational meetings, giving healthcare professionals feedback, giving healthcare professionals learning materials, and using patient decision aids. Shared decisions leads to better outcomes and high patient's satisfaction in breast reconstruction. Citation Format: Maciel-Miranda A, Gutierrez-Zacarias LM, Cabrera-Galeana PA, Bargallo-Rocha E. Shared decision-making approach in breast reconstruction in a developing country [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-10.
Background For the last decade, there has been a significant reduction in hospital length of stay (LOS) after breast cancer surgery, and the last few years there is a tendency of early discharge (ED) rates following mastectomy. We defined same-day surgery (SDS) as admission, surgery and discharge on the same day and ED as hospital length of stay less than 36 hours. Studies show clear benefits with breast cancer patients having SDS such as reduction of hospital and patient costs, faster patient psychological recovery, lower rates of surgical complications and significant reduction of surgical site infection. However, concerns about performing more invasive procedures in an outpatient basis, such as immediate breast reconstruction (BR) is noticeable and few articles addresses this subject. At our institute our goal is to have an early and safely discharge for every patient with low complication rate, independently of the procedure (except for microvascular BR). We sought to describe our early discharge BR program in terms of complication rate and analyze risk factors for one-night hospitalization. Methods IRB approval was obtained for a retrospective review of all BR procedures performed from 2017- 2019 in the National Cancer Institute of Mexico. We selected patients who underwent BR surgeries with or without associated oncologic procedure in a basis of ED mode. Exclusion criteria were microvascular BR and patients who were not admitted the same day of surgery. We analyzed immediate and delayed BR (alloplastic or autologous), oncoplastic procedures and revision surgeries (complications). Demographic, clinical and surgical variables were analyzed in the bivariate analysis. And a logistic regression was used to determine possible risk factors for > 24 hours length of stay (LOS). Results A total of 456 patients were submitted to 692 total breast reconstruction surgeries. We categorized surgical events into 2 groups according to LOS: 419 (61%) in the SDS group with < 24 hours LOS and 273 (39%) in the > 24 hours group. The SDS group had a higher median age (46.7 years versus 44.8; p=0.0265), similar rates of diabetes, systemic hypertension, other comorbidities and ASA class. There is a greater proportion of patients with overweight in the SDS group (47.7% versus 33.7%; p=0.004). SDS group had a median LOS of 9.2 ±2.6 hours versus 33.1± 17.5 hours in the > 24 hours group (p=0.000). In the > 24 hours group the proportion of bilateral surgeries was 29.6% versus 36.8% (p=0.457), MT with alloplastic BR 59.7% versus 24.6% (p=0.000), and axillary lymph node surgery 55% versus 24.5% (p=0.000). Among all surgeries, 131 (18.9%) presented postoperative complications, 14.6% in the SDS group versus 25.6% (p=0.000). The quantity of reconstruction failures was 16 (4.8%). Most common complications were: 10.7% surgical site infection (9.1% in the SDS group versus 13.2%), 9.4 reintervention (7.4% SDS group versus 12.5%),13.6% of emergency room consultation (12.4% SDS group versus 14.3%), 0.6% hematoma. In the multivariate analysis we found significant risk factors for >24 hours LOS were a low educational level, low hemoglobin level, quantity of drains, length of surgery and certain types of surgery such as MT with immediate BR, oncoplastic surgery and autologous BR and presence of axillary lymph node surgery. Conclusions These results demonstrate that an ED breast cancer reconstruction program is safe and effective at our institution. The complication rate for our population is similar to other reported. We also found very positive that although there is no significant difference in complications, reinterventions or readmissions between >24 hours group and patients discharged the same day, there is a slight difference towards less complications in the SDS group which support continue reinforcing our SDS BR program. Citation Format: Juan Enrique Bargallo-Rocha, Daniela Vargas-Salas, Luz M Gutiérrez-Zacarías, Juan A Torres-Domínguez, Judith Acosta-Violante, Erick H Rubio-Arroyo. Effectiveness of a breast reconstruction program with early discharge [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-03.
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