Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction

Le, Nicole K.; Gabrick, Kyle; Chouairi, Fouad; Mets, Elbert J.; Avraham, Tomer; Alperovich, Michael

doi:10.1111/tbj.13849

Cited by 7 publications

(6 citation statements)

References 64 publications

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“…3,11,13,14 Despite the benefits of breast reconstruction, it has been reported to be underused among patients in underserved populations. 6,[15][16][17] Breast reconstruction can be performed at the time of mastectomy or delayed for months to years. 18,19 Immediate reconstruction is generally preferred over delayed reconstruction for better aesthetic results and higher reported patient quality of life scores.…”

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confidence: 99%

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Do Socioeconomic Status and Race Impact the Safety and Efficacy of Breast Reconstruction?

Soto¹,

Fang

Bond

et al. 2023

Ann Plast Surg

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Introduction: Immediate breast reconstruction after mastectomy has increased in recent years when compared with delayed reconstruction. Despite this encouraging trend, racial and socioeconomic disparities in the receipt of postmastectomy breast reconstruction have been well documented. We sought to assess the effect of race, socioeconomic status, and patient comorbidities on muscle sparing transverse rectus abdominis myocutaneous outcomes at our safety net hospital institution in the southeast. Methods: The database of a tertiary referral center was queried for patients who received free transverse rectus abdominis myocutaneous flaps for immediate reconstruction after mastectomy meeting inclusion criteria from 2006 to 2020. Patient demographics and outcomes were compared based on socioeconomic status. The primary outcome (reconstructive success) was defined as breast reconstruction without flap loss. Statistical analysis included analysis of variance and χ 2 tests were appropriate using Rstudio. Results: Three-hundred fourteen patients were included in the study, with 76% White, 16% Black, and 8% other. Overall complication rate at our institution was 17% and reconstructive success was 94%. Non-White race, older age at time of breast cancer diagnosis, higher body mass index, and presence of comorbid conditions including current smoking and hypertension were all associated with low socioeconomic status. Despite this, surgical complication rates were not predicted by non-White race, older age, or presence of diabetes mellitus. When analyzing major and minor complications based on radiation received or reconstructive success, there was no significant difference regardless of radiation treatment with the group overall achieving a 94% success rate (P = 0.229).Conclusions: This study aimed to characterize the impact of socioeconomic status and race/ethnic status of patients on breast reconstruction outcomes at an institution in the South. We found that despite the greater morbidity in low income and ethnic/minority patients that when treated by a comprehensive safety net institution, they had excellent reconstructive outcomes due to low complications and minimal reoperations.

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confidence: 99%

“…Postmastectomy breast reconstruction is an elective procedure that can improve the quality of life of patients and potentially reduce morbidity and mortality from breast cancer 3,11,13,14 . Despite the benefits of breast reconstruction, it has been reported to be underused among patients in underserved populations 6,15–17 …”

mentioning

confidence: 99%

Do Socioeconomic Status and Race Impact the Safety and Efficacy of Breast Reconstruction?

Soto¹,

Fang

Bond

et al. 2023

Ann Plast Surg

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“…a higher perceived quality of care was reported in patients with higher incomes and education levels. In line with this, a study from Yale University reports higher psychological well-being and satisfaction following breast cancer treatment and reconstruction with higher socioeconomic status independent of cancer stage, treatment and baseline patient comorbidities (Le et al , 2020).…”

Section: Discussionmentioning

confidence: 75%

“…Multiple studies have shown that empathy and compassion training in medical education improves patient outcomes, reduces patient depression and improves quality of life (Trzeciak et al , 2017; Burns and Nolen-Hoeksema, 1992). Moreover, assistance in the form of increased attention and dedicated hospital resources well beyond the initial treatment period may help with coping (Le et al , 2020).…”

Section: Discussionmentioning

confidence: 99%

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions

Fayyaz

Ahmed

Abid

et al. 2020

IJHCQA

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PurposeThis study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.Design/methodology/approachThis is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.FindingsThe authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of “satisfied” responses as the household income increased.Research limitations/implicationsA comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.Practical implicationsAssessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.Social implicationsAfter being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.Originality/valueCancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

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“…[22][23][24][25][26] One study examined the association between socioeconomic status and BREAST-Q scores after breast reconstruction, but this study used Zillow to estimate patients' incomes rather than having patients report their incomes, which may contribute to inaccuracies. 27 Therefore, a more comprehensive examination of SDOH and PROs after breast reconstruction is necessary by using insurance status as a proxy.…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

Plotsker,

Graziano,

Kim

et al. 2024

J Reconstr Microsurg

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Introduction: Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: We retrospectively examined patients who received DIEP flaps at our institution from 2010-2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher’s exact, Kruskal-Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module. Results: 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significant higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-Being of the Chest (PWBC) than patients with commercial insurance (β =-3.1, 95% CI: -5.0, -1.2, p=0.002). There were no significant associations between insurance classification and other domains of the BREAST-Q. Conclusion: Patients with government issued insurance had lower success rates of autologous breast reconstruction. Further, Patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.

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Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction

Cited by 7 publications

References 64 publications

Do Socioeconomic Status and Race Impact the Safety and Efficacy of Breast Reconstruction?

Do Socioeconomic Status and Race Impact the Safety and Efficacy of Breast Reconstruction?

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy

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