Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

Abstract

Background Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socio-economic factors associated with reconstruction in a contemporary cohort. Methods Using the National Cancer Database, we identified women < 75 years of age with stage 0-1 breast cancer treated with mastectomy (n=297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis. Annual percent change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n=145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Results Immediate reconstruction rates increased from 27% to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APC’s across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who live in areas with the lowest rates of high school graduation (black 42.4 (40.5-44.3)%, white 45.7 (43.9-47.4)%). Conclusions Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction and identifying modifiable factors are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care.

Krūtų Rekonstrukcinių Operacijų Silikoniniais Implantais Komplikacijos. Klaipėdos Universitetinės Ligoninės Retrospektyvinė Duomenų Analizė

“…Seniai įrodyta, jog krūties atstatymas yra tiesiogiai susijęs su geresne moters gyvenimo kokybe, apimant geresnę seksualinę, psichosocialinę bei fizinę jos funkciją. Tai taipogi yra krūties vėžio gydymo kokybės rodiklis [3]. Krūtį atstatančių operacijų skaičius JAV per 15 metų išaugo nuo 11,6% (1998 m.) iki 48% (2013 m.).…”

“…Moterų, kurioms buvo galima atlikti krūtį tausojančias operacijas, vietoje jos pasirinkusių mastektomijas, skaičius išaugo nuo 34,3% (1998 m.) iki 37,8% (2011 m.). Taip pat abipusę mastektomiją esant vienos krūties onkologiniam susirgimui 2011 m. pasirinko 11,2% moterų, kai 1998 m. tokių moterų buvo tik 1,9% [3,4]. Egzistuoja keletas teorijų tokiam radikaliam moterų pasirinkimui paaiškinti.…”

“…Literatūroje aprašomos trys pagrindinės sąlygos, kurios lemia, ar konkrečiai ligonei bus atlikta rekonstrukcinė krūties operacija. Tai -tinkamumas operacijai (klinikiniai duomenys, moters išsilavinimas), ligonės motyvacija ir galimybė šią operaciją atlikti (ar chirurgas, kuris gydo ligonę, geba atlikti tokio tipo operaciją, ar tokio tipo operacijos atliekamos centre, kuriame gydoma moteris) [3]. Esant nustatytam vienodam vėžio atkryčio dažniui, visame pasaulyje vis dažniau atliekamos krūtų rekonstrukcijos implantais.…”

Influence of socioeconomic status on immediate breast reconstruction rate, patient information and involvement in surgical decision-making

“…Known contributing factors in the choice of IBR versus DBR versus no reconstruction are tumour characteristics, expected oncological treatment, surgical competence and resources, patient co‐morbidity and body habitus, and patient preference. Moreover, retrospective cohort studies have shown that non‐white ethnicity, lower education, older age and single status decrease the likelihood of having IBR. In a Danish study, the rate of IBR was significantly higher among women with higher education and in hospitals with plastic surgery departments.…”

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

“…26 Further, lower SES has been linked with a lower probability to undergo breast-conserving therapy or immediate breast reconstruction. 27,29 Yet, the impact of SES on psychological functioning and perceived satisfaction in survivorship has yet to be quantified.…”