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Published in: Supportive Care in Cancer 6/2019

01-06-2019 | Original Article

Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer

Authors: P. S. Soon, S. Ruban, H. T. J. Mo, R. Lee, L. Saliba, A. Shah, D. Segara, S. Yarrow, A. Girgis

Published in: Supportive Care in Cancer | Issue 6/2019

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Abstract

Purpose

In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%.
This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women’s reconstruction decisions.

Methods

Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic).

Results

Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction.

Conclusions

Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients’ decisions about breast reconstruction, especially for non-English speaking patients.
Literature
1.
go back to reference Ferlay J et al (2013) Cancer Incidence and Mortality Worldwide: IARC CancerBase. In: GLOBOCAN 2012 (online). International Agency for Research on Cancer, Lyon Ferlay J et al (2013) Cancer Incidence and Mortality Worldwide: IARC CancerBase. In: GLOBOCAN 2012 (online). International Agency for Research on Cancer, Lyon
2.
go back to reference AIHW (2016) Australian Cancer Incidence and Mortality (ACIM) books: breast cancer. AIHW, Canberra AIHW (2016) Australian Cancer Incidence and Mortality (ACIM) books: breast cancer. AIHW, Canberra
3.
go back to reference Kwok C, White K (2011) Cultural and linguistic isolation: the breast cancer experience of Chinese-Australian women - a qualitative study. Contemp Nurse 39(1):85–94CrossRefPubMed Kwok C, White K (2011) Cultural and linguistic isolation: the breast cancer experience of Chinese-Australian women - a qualitative study. Contemp Nurse 39(1):85–94CrossRefPubMed
4.
go back to reference Boehmke MM, Dickerson SS (2005) Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nurs 28(5):382–389CrossRefPubMed Boehmke MM, Dickerson SS (2005) Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nurs 28(5):382–389CrossRefPubMed
5.
go back to reference Ditsch N, Bauerfeind I, Vodermaier A, Tripp C, Löhrs B, Toth B, Himsl I, Graeser M, Harbeck N, Lenhard M (2013) A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Arch Gynecol Obstet 287:555–561CrossRefPubMed Ditsch N, Bauerfeind I, Vodermaier A, Tripp C, Löhrs B, Toth B, Himsl I, Graeser M, Harbeck N, Lenhard M (2013) A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Arch Gynecol Obstet 287:555–561CrossRefPubMed
6.
go back to reference National Breast and Ovarian Cancer Centre (2010) National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons National Breast Cancer Audit Public Health Monitoring Series 2008 Data. National Breast and Ovarian Cancer Centre, Surry Hills National Breast and Ovarian Cancer Centre (2010) National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons National Breast Cancer Audit Public Health Monitoring Series 2008 Data. National Breast and Ovarian Cancer Centre, Surry Hills
8.
go back to reference Reuben BC, Manwaring J, Neumayer LA (2009) Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States. Am J Surg 198(2):237–243CrossRefPubMed Reuben BC, Manwaring J, Neumayer LA (2009) Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States. Am J Surg 198(2):237–243CrossRefPubMed
9.
go back to reference Cordeiro PG (2008) Breast reconstruction after surgery for breast cancer. N Engl J Med 359(15):1590–1601CrossRefPubMed Cordeiro PG (2008) Breast reconstruction after surgery for breast cancer. N Engl J Med 359(15):1590–1601CrossRefPubMed
10.
go back to reference Eriksen C, Frisell J, Wickman M, Lidbrink E, Krawiec K, Sandelin K (2011) Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study. Breast Cancer Res Treat 127(2):439–446CrossRefPubMed Eriksen C, Frisell J, Wickman M, Lidbrink E, Krawiec K, Sandelin K (2011) Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study. Breast Cancer Res Treat 127(2):439–446CrossRefPubMed
11.
go back to reference Heneghan HM, Prichard RS, Lyons R, Regan PJ, Kelly JL, Malone C, McLaughlin R, Sweeney KJ, Kerin MJ (2011) Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol 37(11):937–943CrossRefPubMed Heneghan HM, Prichard RS, Lyons R, Regan PJ, Kelly JL, Malone C, McLaughlin R, Sweeney KJ, Kerin MJ (2011) Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol 37(11):937–943CrossRefPubMed
12.
go back to reference Mustonen P et al (2004) The surgical and oncological safety of immediate breast reconstruction. Eur J Surg Oncol 30(8):817–823CrossRefPubMed Mustonen P et al (2004) The surgical and oncological safety of immediate breast reconstruction. Eur J Surg Oncol 30(8):817–823CrossRefPubMed
13.
go back to reference Handel N, Silverstein MJ, Waisman E, Waisman JR (1990) Reasons why mastectomy patients do not have breast reconstruction. Plast Reconstr Surg 86(6):1118–1122CrossRefPubMed Handel N, Silverstein MJ, Waisman E, Waisman JR (1990) Reasons why mastectomy patients do not have breast reconstruction. Plast Reconstr Surg 86(6):1118–1122CrossRefPubMed
14.
go back to reference Platt J, Baxter N, Zhong T (2011) Breast reconstruction after mastectomy for breast reconstruction. Can Med Assoc J 183(18):2109–2116CrossRef Platt J, Baxter N, Zhong T (2011) Breast reconstruction after mastectomy for breast reconstruction. Can Med Assoc J 183(18):2109–2116CrossRef
15.
go back to reference Schain WS, Jacobs E, Wellisch DK (1984) Psychosocial issues in breast reconstruction. Intrapsychic, interpersonal, and practical concerns. Clin Plast Surg 11(2):237–251PubMed Schain WS, Jacobs E, Wellisch DK (1984) Psychosocial issues in breast reconstruction. Intrapsychic, interpersonal, and practical concerns. Clin Plast Surg 11(2):237–251PubMed
16.
go back to reference Schain WS et al (1985) The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction. Am J Psychiatry 142(1):40–46CrossRefPubMed Schain WS et al (1985) The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction. Am J Psychiatry 142(1):40–46CrossRefPubMed
17.
go back to reference Lam TC, Winch CJ (2016) What would women choose when given a choice in breast reconstruction?. Plastic and reconstructive surgery. Global Open 4(9):e1062 Lam TC, Winch CJ (2016) What would women choose when given a choice in breast reconstruction?. Plastic and reconstructive surgery. Global Open 4(9):e1062
18.
go back to reference Flitcroft K et al (2016) Documenting patterns of breast reconstruction in Australia: the national picture. Breast 30:47–53CrossRefPubMed Flitcroft K et al (2016) Documenting patterns of breast reconstruction in Australia: the national picture. Breast 30:47–53CrossRefPubMed
19.
go back to reference Jeevan R, Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury RM, Cromwell DA (2016) National trends and regional variation in immediate breast reconstruction rates. Br J Surg 103(9):1147–1156CrossRefPubMed Jeevan R, Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury RM, Cromwell DA (2016) National trends and regional variation in immediate breast reconstruction rates. Br J Surg 103(9):1147–1156CrossRefPubMed
20.
go back to reference Chiu AS, Thomas P, Killelea BK, Horowitz N, Chagpar AB, Lannin DR (2017) Regional variation in breast cancer surgery: results from the National Cancer Database (NCDB). Am J Surg 214(5):907–913CrossRefPubMed Chiu AS, Thomas P, Killelea BK, Horowitz N, Chagpar AB, Lannin DR (2017) Regional variation in breast cancer surgery: results from the National Cancer Database (NCDB). Am J Surg 214(5):907–913CrossRefPubMed
21.
go back to reference Wong A et al (2014) Increasing breast reconstruction rates by offering more women a choice. Breast 84:31–36 Wong A et al (2014) Increasing breast reconstruction rates by offering more women a choice. Breast 84:31–36
22.
go back to reference Lee C, Hultman C, Sepucha K (2010) What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg 64(5):567–569PubMed Lee C, Hultman C, Sepucha K (2010) What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg 64(5):567–569PubMed
23.
go back to reference Manne S, Topham N, D'Agostino TA, Myers Virtue S, Kirstein L, Brill K, Manning C, Grana G, Schwartz MD, Ohman-Strickland P (2015) Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psycho-Oncology 25(12):1424–1433CrossRefPubMed Manne S, Topham N, D'Agostino TA, Myers Virtue S, Kirstein L, Brill K, Manning C, Grana G, Schwartz MD, Ohman-Strickland P (2015) Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psycho-Oncology 25(12):1424–1433CrossRefPubMed
24.
go back to reference Murray CD, Turner A, Rehan C, Kovacs T (2015) Satisfaction following immediate breast reconstruction: experiences in the early post-operative stage. Br J Health Psychol 20(3):579–593CrossRefPubMed Murray CD, Turner A, Rehan C, Kovacs T (2015) Satisfaction following immediate breast reconstruction: experiences in the early post-operative stage. Br J Health Psychol 20(3):579–593CrossRefPubMed
25.
go back to reference Sepucha KR, Fowler FJ Jr, Mulley AG Jr (2004) Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff Suppl Variation: VAR54–62 Sepucha KR, Fowler FJ Jr, Mulley AG Jr (2004) Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff Suppl Variation: VAR54–62
26.
go back to reference Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women revisit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefPubMedPubMedCentral Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women revisit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefPubMedPubMedCentral
27.
go back to reference Hequet D et al (2013) Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus 2:325CrossRefPubMedPubMedCentral Hequet D et al (2013) Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus 2:325CrossRefPubMedPubMedCentral
28.
go back to reference Cancer Australia (2016) Cancer Australia Statement - Influencing best practice in breast cancer. Cancer Australia, Surry Hills Cancer Australia (2016) Cancer Australia Statement - Influencing best practice in breast cancer. Cancer Australia, Surry Hills
29.
go back to reference National_Institute_for_Health_and_Care_Excellence (2009) Early and locally advanced breast cancer: diagnosis and treatment. NICE guidelines [CG80]. National Collaborating Centre for Cancer, Cardiff National_Institute_for_Health_and_Care_Excellence (2009) Early and locally advanced breast cancer: diagnosis and treatment. NICE guidelines [CG80]. National Collaborating Centre for Cancer, Cardiff
30.
go back to reference Morrow M, Scott SK, Menck HR, Mustoe TA, Winchester DP (2001) Factors influencing the use of breast reconstruction postmastectomy: a national cancer database study. J Am Coll Surg 192(1):1–8CrossRefPubMed Morrow M, Scott SK, Menck HR, Mustoe TA, Winchester DP (2001) Factors influencing the use of breast reconstruction postmastectomy: a national cancer database study. J Am Coll Surg 192(1):1–8CrossRefPubMed
31.
go back to reference Desch CE, Penberthy LT, Hillner BE, McDonald MK, Smith TJ, Pozez AL, Retchin SM (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy and conservative surgery. Surgery 125(4):441–447CrossRefPubMed Desch CE, Penberthy LT, Hillner BE, McDonald MK, Smith TJ, Pozez AL, Retchin SM (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy and conservative surgery. Surgery 125(4):441–447CrossRefPubMed
32.
go back to reference Polednak AP (2001) How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg 108:73–77CrossRefPubMed Polednak AP (2001) How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg 108:73–77CrossRefPubMed
33.
go back to reference Polednak AP (1999) Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg 104(3):669–673CrossRefPubMed Polednak AP (1999) Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg 104(3):669–673CrossRefPubMed
34.
go back to reference South Western Sydney Local Health District, SWSLHD year in review 2015/2016. 2016 South Western Sydney Local Health District, SWSLHD year in review 2015/2016. 2016
35.
go back to reference Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women visit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefPubMedPubMedCentral Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women visit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefPubMedPubMedCentral
36.
go back to reference Alderman AK, Hawley ST, Janz NK, Mujahid MS, Morrow M, Hamilton AS, Graff JJ, Katz SJ (2009) Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study. J Clin Oncol 27(32):5325–5330CrossRefPubMedPubMedCentral Alderman AK, Hawley ST, Janz NK, Mujahid MS, Morrow M, Hamilton AS, Graff JJ, Katz SJ (2009) Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study. J Clin Oncol 27(32):5325–5330CrossRefPubMedPubMedCentral
37.
go back to reference Morrow M, Li Y, Alderman AK, Jagsi R, Hamilton AS, Graff JJ, Hawley ST, Katz SJ (2014) Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 149(10):1015–1021CrossRefPubMedPubMedCentral Morrow M, Li Y, Alderman AK, Jagsi R, Hamilton AS, Graff JJ, Hawley ST, Katz SJ (2014) Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 149(10):1015–1021CrossRefPubMedPubMedCentral
38.
go back to reference Bell RJ, Robinson PJ, Fradkin P, Schwarz M, Davis SR (2012) Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia. Breast J 21(3):394–400 Bell RJ, Robinson PJ, Fradkin P, Schwarz M, Davis SR (2012) Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia. Breast J 21(3):394–400
39.
go back to reference Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ (2016) Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 76(6):640–644CrossRefPubMed Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ (2016) Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 76(6):640–644CrossRefPubMed
40.
go back to reference Flitcroft K, Brennan M, Spillane A (2017) Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: a systematic review. Psychooncology Flitcroft K, Brennan M, Spillane A (2017) Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: a systematic review. Psychooncology
41.
go back to reference Smith A, Agar M, Delaney G, Descallar J, Dobell-Brown K, Grand M, Aung J, Patel P, Kaadan N, Girgis A (2018) Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers. Asia Pac J Clin Oncol 14(1):52–60 Smith A, Agar M, Delaney G, Descallar J, Dobell-Brown K, Grand M, Aung J, Patel P, Kaadan N, Girgis A (2018) Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers. Asia Pac J Clin Oncol 14(1):52–60
42.
go back to reference Meiser B, Kaur R, Zilliacus E, Wong T, Woodland L, Tomkins S, Kissane D, Girgis A, Butow P, Hale S, Perry A, Aranda SK, Shaw T, Tebble H, Goldstein D (2017) Evaluation of an online communications skills training programme for oncology health care professionals working with patients from minority backgrounds. Asia Pac J Clin Oncol 13:66 Meiser B, Kaur R, Zilliacus E, Wong T, Woodland L, Tomkins S, Kissane D, Girgis A, Butow P, Hale S, Perry A, Aranda SK, Shaw T, Tebble H, Goldstein D (2017) Evaluation of an online communications skills training programme for oncology health care professionals working with patients from minority backgrounds. Asia Pac J Clin Oncol 13:66
Metadata
Title
Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer
Authors
P. S. Soon
S. Ruban
H. T. J. Mo
R. Lee
L. Saliba
A. Shah
D. Segara
S. Yarrow
A. Girgis
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4470-0

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