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Variation in Physician-patient Discussion of Breast Reconstruction

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ABSTRACT

BACKGROUND

For women with early stage breast cancer, physician-patient discussion of breast reconstruction is an essential step in their participation in the decision-making process for their treatments. This study examines sociodemographic variation of physician-patient discussion of breast reconstruction and explores the impact of this discussion on the use of breast reconstruction.

METHODS

We used data from the Los Angeles Women’s Study, a population-based study of women 50 years and older with breast cancer. Bivariate and multivariate logistic regression models were used to estimate the impact of patient and hospital characteristics on self-reported receipt of physician-patient discussion and use of breast reconstruction.

RESULTS

Of 315 post-mastectomy women, 81% and 27% reported physician-patient discussion and use of breast reconstruction, respectively. In multivariable analysis, women with an annual income <$20,000 were less likely to have physician-patient discussion than women with annual income ≥$40,000 (OR = 0.23, 95% CI 0.07–0.82). Among the subset of women with physician-patient discussion, chest wall radiation, a known characteristic associated with higher rates of reconstruction complications, became an additional significant negative predictor of reconstruction.

CONCLUSIONS

Lower income women are at risk of not receiving physician-patient discussion of breast reconstruction. Physician-patient discussion of breast reconstruction appears to decrease the use of breast reconstruction among women with clinical characteristics associated with higher rates of reconstruction complications and failure. This highlights the need for interventions to increase physician-patient discussion of breast reconstruction among lower income women.

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References

  1. United States Cancer Statistics. 2002 Incidence and Mortality. Atlanta: U.S. Department of Health and Human Services, Center for Disease Control and Prevention and National Cancer Institute; 2005.

    Google Scholar 

  2. Morrow M, Mujahid M, Lantz PM, et al. Correlates of breast reconstruction: results from a population-based study. Cancer. 2005;104(11):2340–6. Dec 1.

    Article  PubMed  Google Scholar 

  3. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet. 1983;1(8322):459–62. Feb 26.

    Article  PubMed  CAS  Google Scholar 

  4. Filiberti A, Tamburini M, Murru L, et al. Psychologic effects and esthetic results of breast reconstruction after mastectomy. Tumori. 1986;72(6):585–8. Dec 31.

    PubMed  CAS  Google Scholar 

  5. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422–9. Sep 6.

    Article  PubMed  CAS  Google Scholar 

  6. Rowland JH, Holland JC, Chaglassian T, Kinne D. Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning. Psychosomatics. 1993;34(3):241–50. May–Jun.

    PubMed  CAS  Google Scholar 

  7. Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: 1-year postoperative results from the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg. 2000;106(5):1014–25. discussion 1026–17, Oct.

    Article  PubMed  CAS  Google Scholar 

  8. Harcourt D, Rumsey N. Psychological aspects of breast reconstruction: a review of the literature. J Adv Nurs. 2001;35(4):477–87. Aug.

    Article  PubMed  CAS  Google Scholar 

  9. Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520–28. Apr.

    PubMed  CAS  Google Scholar 

  10. Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3(5):448–57. Sep–Oct.

    Article  PubMed  CAS  Google Scholar 

  11. Moyer A, Salovey P. Patient participation in treatment decision making and the psychological consequences of breast cancer surgery. Womens Health. 1998;4(2):103–16. Summer.

    PubMed  CAS  Google Scholar 

  12. Street RL Jr, Voigt B. Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Making. 1997;17(3):298–306. Jul–Sep.

    Article  PubMed  Google Scholar 

  13. Alderman AK, McMahon L Jr, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg. 2003;111(2):695–703. discussion 704–695, Feb.

    Article  PubMed  Google Scholar 

  14. Christian CK, Niland J, Edge SB, et al. A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network. Ann Surg. 2006;243(2):241–9. Feb.

    Article  PubMed  Google Scholar 

  15. Desch CE, Penberthy LT, Hillner BE, et al. A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery. 1999;125(4):441–7. Apr.

    PubMed  CAS  Google Scholar 

  16. Morrow M, White J, Moughan J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol. 2001;19:2254–62.

    PubMed  CAS  Google Scholar 

  17. Polednak AP. Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg. 1999;104(3):669–73. Sep.

    Article  PubMed  CAS  Google Scholar 

  18. Polednak AP. Type of breast reconstructive surgery among breast cancer patients: a population-based study. Plast Reconstr Surg. 2001;108(6):1600–3. Nov.

    Article  PubMed  CAS  Google Scholar 

  19. Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ. 2002;325(7370):961–4. Oct 26.

    Article  PubMed  Google Scholar 

  20. Braddock CH 3rd, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. Jama. 1999;282(24):2313–20. Dec 22–29.

    Article  PubMed  Google Scholar 

  21. Greenberg CC, Schneider EC, Lipsitz SR, et al. Do variation in provider discussions explain socioeconomic disparities in post-mastectomy breast reconstruction? American College of Surgeons; 2008.

  22. Yoon J, Malin JL, Tao ML, et al. Symptoms after breast cancer treatment: are they influenced by patient characteristics? Breast Cancer Res Treat. May 10 2007.

  23. Yoon J, Malin JL, Tisnado DM, et al. Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Res Treat. Jul 19 2007.

  24. Pearson ML, Ganz PA, McGuigan K, Malin JL, Adams J, Kahn KL. The case identification challenge in measuring quality of cancer care. J Clin Oncol. 2002;20(21):4353–60.

    Article  PubMed  Google Scholar 

  25. Kahn KL, Tisnado DM, Adams JL, et al. Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease? Health Serv Res. 2007;42(1 Pt 1):63–83. Feb.

    Article  PubMed  Google Scholar 

  26. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. Mar.

    Article  PubMed  Google Scholar 

  27. Spear SL, Ducic I, Low M, Cuoco F. The effect of radiation on pedicled TRAM flap breast reconstruction: outcomes and implications. Plast Reconstr Surg. 2005;115(1):84–95. Jan.

    PubMed  CAS  Google Scholar 

  28. Spear SL, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trends and therapeutic implications. Plast Reconstr Surg. 2000;105(3):930–42. Mar.

    Article  PubMed  CAS  Google Scholar 

  29. Krueger EA, Wilkins EG, Strawderman M, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys. 2001;49(3):713–21. Mar 1.

    PubMed  CAS  Google Scholar 

  30. Tallet AV, Salem N, Moutardier V, et al. Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results. Int J Radiat Oncol Biol Phys. 2003;57(1):136–42. Sep 1.

    PubMed  Google Scholar 

  31. Barreau-Pouhaer L, Le MG, Rietjens M, et al. Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancer. Cancer. 1992;70(5):1145–51. Sep 1.

    Article  PubMed  CAS  Google Scholar 

  32. Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE. AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum. 1992;35:1–10.

    Article  PubMed  CAS  Google Scholar 

  33. American Hospital Association Health Forum LLC (1994–1999): Annual Survey of Hospitals. Chicago: American Hospital Association.

  34. California Office of Statewide Health Planning and Development. Hospital Discharge Abstract Data Set: Sacramento California; 2000.

  35. Hosmer DWJSL. Applied Logistic Regression, 2nd edn. New York: Wiley; 2000.

    Google Scholar 

  36. Hosmer DWJLS. Applied Logistic Regression. New York: John Wiley; 1989.

    Google Scholar 

  37. U.S. Departments of Labor and Health and Human Services. Your Rights after a Mastectomy: Women’s Health and Cancer Rights Act of 1998. http://www.dol.gov/ebsa/publications/whcra.html. Accessed October 20, 2008, 2008.

  38. Hewitt M, Simone, Joseph V, eds. National Cancer Policy Board, Institute of Medicine and National Research Council Ensuring Quality Cancer Care. Washington D.C.: The National Academies Press; 1999.

  39. Schneider EC, Malin JL, Kahn KL, Emanuel EJ, Epstein AM. Developing a system to assess the quality of cancer care: ASCO’s national initiative on cancer care quality. J Clin Oncol. 2004;22(15):2985–91. Aug 1.

    Article  PubMed  Google Scholar 

  40. Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24(4):626–34. Feb 1.

    Article  PubMed  Google Scholar 

  41. Salkeld G, Solomon M, Short L, Butow PN. A matter of trust-patient’s views on decision-making in colorectal cancer. Health Expect. 2004;7(2):104–14. Jun.

    Article  PubMed  Google Scholar 

  42. http://aspe.hhs.gov/hsp/06/Catalog-AI-AN-NA/BRFSS.htm. Date accessed October 20, 2008. Behavioral Risk Factor Surveillance System (BRFSS) [

  43. Yoon J, Malin JL, Tao ML, et al. Symptoms after breast cancer treatment: are they influenced by patient characteristics? Breast Cancer Res Treat. 2008;108(2):153–65. Mar.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding is from the National Cancer Institute (NCI) grant no. R01 CA81338-01A1.

The authors thank Dennis Deapen of Los Angeles County Registry for allowing access to the Rapid Case Ascertainment program and to Scott Hickey for statistical programming. Katherine Kahn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. There is no potential conflict of interest for the authors of this manuscript.

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Authors and Affiliations

  1. University of California, Los Angeles, CA, USA

    Judy Y. Chen MD MSHS, Patricia A. Ganz MD, Clifford Ko MD MS MSHS, Diana Tisnado PhD & May Lin Tao MD MS

  2. Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA

    Jennifer Malin MD PhD

  3. Valley Radiotherapy Associates Medical Group, El Segundo, CA, USA

    May Lin Tao MD MS

  4. RAND, Santa Monica, CA, USA

    Martha Timmer MS, John L. Adams PhD & Katherine L. Kahn MD

  5. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA

    Katherine L. Kahn MD

Authors
  1. Judy Y. Chen MD MSHS
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  2. Jennifer Malin MD PhD
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  3. Patricia A. Ganz MD
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  4. Clifford Ko MD MS MSHS
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  6. May Lin Tao MD MS
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  9. Katherine L. Kahn MD
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Correspondence to Katherine L. Kahn MD.

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Chen, J.Y., Malin, J., Ganz, P.A. et al. Variation in Physician-patient Discussion of Breast Reconstruction. J GEN INTERN MED 24, 99–104 (2009). https://doi.org/10.1007/s11606-008-0855-y

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  • DOI: https://doi.org/10.1007/s11606-008-0855-y

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