Top

Published in:

06-08-2022 | Mastectomy | Reconstructive Oncology

Impact of Patient Primary Language upon Immediate Breast Reconstruction After Mastectomy

Authors: Alison P. Woods, MD, Marianna V. Papageorge, MD, Susanna W. L. de Geus, MD, PhD, Andrea Alonso, MD, Andrea Merrill, MD, Michael R. Cassidy, MD, Daniel S. Roh, MD, PhD, Teviah E. Sachs, MD, MPH, David McAneny, MD, Frederick Thurston Drake, MD, MPH

Published in: Annals of Surgical Oncology | Issue 13/2022

Abstract

Background

Preoperative decision-making in patients who speak a primary language other than English is understudied. We investigated whether patient primary language is associated with differences in immediate breast reconstruction (IBR) after mastectomy.

Patients and Methods

This retrospective observational study analyzed female patients undergoing mastectomy in the New Jersey State Inpatient Database (2009–2014). The primary outcome was the odds of IBR with a prespecified subanalysis of autologous tissue-based IBR. We used multivariable logistic regression and hierarchical generalized linear mixed models to control for patient characteristics and nesting within hospitals.

Results

Of 13,846 discharges, 12,924 (93.3%) specified English as the patient’s primary language, while 922 (6.7%) specified a language other than English. Among English-speaking patients, 6178 (47.8%) underwent IBR, including 2310 (17.9%) autologous reconstructions. Among patients with a primary language other than English, 339 (36.8%) underwent IBR, including 93 (10.1%) autologous reconstructions. Unadjusted results showed reduced odds of IBR overall [odds ratio (OR) 0.64, 95% CI 0.55–0.73], and autologous reconstruction specifically (OR 0.52, 95% CI 0.41–0.64) among patients with a primary language other than English. After adjustment for patient factors, this difference persisted among the autologous subgroup (OR 0.64, 95% CI 0.51–0.80) but not for IBR overall. A hierarchical model incorporating both patient characteristics and hospital-level effects continued to show a difference among the autologous subgroup (OR 0.75, 95% CI 0.58–0.97).

Conclusions

Primary language other than English was an independent risk factor for lower odds of autologous IBR after adjustments for patient and hospital effects. Focused efforts should be made to ensure that patients who speak a primary language other than English have access to high-quality shared decision-making for postmastectomy IBR.

U.S. Census Bureau. Detailed languages spoken at home and ability to speak English. https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html. Accessed 11 Oct 2020.

U.S. Department of Health and Human Services. CLAS Standards. Think cultural health. https://thinkculturalhealth.hhs.gov/. Accessed 27 June 2021.

Inagaki E, Farber A, Kalish J, et al. Role of language discordance in complication and readmission rate after infrainguinal bypass. J Vasc Surg. 2017;66(5):1473–8. https://doi.org/10.1016/j.jvs.2017.03.453.CrossRefPubMed

Feeney T, Cassidy M, Tripodis Y, et al. Association of primary language with outcomes after operations typically performed to treat cancer: analysis of a statewide database. Ann Surg Oncol. 2019;26(9):2684–93. https://doi.org/10.1245/s10434-019-07484-8.CrossRefPubMed

Feeney T, Sanchez SE, Tripodis Y, et al. The association of primary language with emergency general surgery outcomes using a statewide database. J Surg Res. 2019;244:484–91. https://doi.org/10.1016/j.jss.2019.06.082.CrossRefPubMed

Tang EW, Go J, Kwok A, et al. The relationship between language proficiency and surgical length of stay following cardiac bypass surgery. Eur J Cardiovasc Nurs J Work Group Cardiovasc Nurs Eur Soc Cardiol. 2016;15(6):438–46. https://doi.org/10.1177/1474515115596645.CrossRef

Sandroussi C, Brace C, Kennedy ED, Baxter NN, Gallinger S, Wei AC. Sociodemographics and comorbidities influence decisions to undergo pancreatic resection for neoplastic lesions. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2010;14(9):1401–8. https://doi.org/10.1007/s11605-010-1255-2.CrossRef

Sridhar P, Misir P, Kwak H, et al. Impact of race, insurance status, and primary language on presentation, treatment, and outcomes of patients with pancreatic adenocarcinoma at a safety-net hospital. J Am Coll Surg. 2019;229(4):389–96. https://doi.org/10.1016/j.jamcollsurg.2019.05.027.CrossRefPubMed

Asokan S, Sridhar P, Qureshi MM, et al. Presentation, treatment, and outcomes of vulnerable populations with esophageal cancer treated at a safety-net hospital. Semin Thorac Cardiovasc Surg. 2020;32(2):347–54. https://doi.org/10.1053/j.semtcvs.2019.12.008.CrossRefPubMed

10.

Himmelstein J, Himmelstein DU, Woolhandler S, et al. Health care spending and use among hispanic adults with and without limited english proficiency, 1999–2018. Health Aff (Millwood). 2021;40(7):1126–34. https://doi.org/10.1377/hlthaff.2020.02510.CrossRef

11.

Cordova LZ, Hunter-Smith DJ, Rozen WM. Patient reported outcome measures (PROMs) following mastectomy with breast reconstruction or without reconstruction: a systematic review. Gland Surg. 2019;8(4):441–51. https://doi.org/10.21037/gs.2019.07.02.CrossRefPubMedPubMedCentral

12.

Dauplat J, Kwiatkowski F, Rouanet P, et al. Quality of life after mastectomy with or without immediate breast reconstruction. Br J Surg. 2017;104(9):1197–206. https://doi.org/10.1002/bjs.10537.CrossRefPubMed

13.

Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet Lond Engl. 1983;1(8322):459–62. https://doi.org/10.1016/s0140-6736(83)91452-6.CrossRef

14.

Stevens LA, McGrath MH, Druss RG, Kister SJ, Gump FE, Forde KA. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73(4):619–26.CrossRefPubMed

15.

van Bommel ACM, de Ligt KM, Schreuder K, et al. The added value of immediate breast reconstruction to health-related quality of life of breast cancer patients. Eur J Surg Oncol. 2020;46(10, Part A):1848–53. https://doi.org/10.1016/j.ejso.2020.06.009.CrossRefPubMed

16.

Alderman A, Gutowski K, Ahuja A, Gray D. ASPS clinical practice guideline summary on breast reconstruction with expanders and implants. Plast Reconstr Surg. 2014;134(4):648e–55e. https://doi.org/10.1097/PRS.0000000000000541.CrossRefPubMed

17.

Thorarinsson A, Fröjd V, Kölby L, Ljungdal J, Taft C, Mark H. Long-term health-related quality of life after breast reconstruction: comparing 4 different methods of reconstruction. Plast Reconstr Surg Glob Open. 2017;5(6):e1316. https://doi.org/10.1097/GOX.0000000000001316.CrossRefPubMedPubMedCentral

18.

Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol. 2017;35(22):2499–506. https://doi.org/10.1200/JCO.2016.69.9561.CrossRefPubMedPubMedCentral

19.

Tseng JF, Kronowitz SJ, Sun CC, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer. 2004;101(7):1514–23. https://doi.org/10.1002/cncr.20529.CrossRefPubMed

20.

Yang RL, Newman AS, Reinke CE, et al. Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes. Ann Surg Oncol. 2013;20(2):399–406. https://doi.org/10.1245/s10434-012-2607-9.CrossRefPubMed

21.

Offodile AC, Tsai TC, Wenger JB, Guo L. Racial disparities in the type of postmastectomy reconstruction chosen. J Surg Res. 2015;195(1):368–76. https://doi.org/10.1016/j.jss.2015.01.013.CrossRefPubMed

22.

Daar DA, Abdou SA, Robinson IS, Levine JP, Thanik V. Disparities in postmastectomy breast reconstruction: a systematic review of the literature and modified framework for advancing research toward intervention. Ann Plast Surg. 2018;81(4):495–502. https://doi.org/10.1097/SAP.0000000000001503.CrossRefPubMed

23.

Soon PS, Ruban S, Mo HTJ, et al. Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2019;27(6):2135–42. https://doi.org/10.1007/s00520-018-4470-0.CrossRef

24.

Momoh AO, Griffith KA, Hawley ST, et al. Patterns and correlates of knowledge, communication, and receipt of breast reconstruction in a modern population-based cohort of patients with breast cancer. Plast Reconstr Surg. 2019;144(2):303–13. https://doi.org/10.1097/PRS.0000000000005803.CrossRefPubMedPubMedCentral

25.

Ashing KT, George M, Jones V. Health-related quality of life and care satisfaction outcomes: informing psychosocial oncology care among Latina and African-American young breast cancer survivors. Psychooncology. 2018;27(4):1213–20. https://doi.org/10.1002/pon.4650.CrossRefPubMed

26.

Healthcare Cost and Utilization Project. HCUP-US SID Overview. Accessed 11 July 2021. https://www.hcup-us.ahrq.gov/sidoverview.jsp

27.

State of New Jersey Department of Health. NJ Hospital Discharge Data Collection System (NJDDCS). https://www.nj.gov/health/healthcarequality/health-care-professionals/njddcs/. Accessed 8 Oct 2021.

28.

Healthcare Cost and Utilization Project. SID: File composition—number of hospitals by year. https://www.hcup-us.ahrq.gov/db/state/siddist/siddist_hospital.jsp. Accessed 11 July 2021.

29.

U.S. Census Bureau. QuickFacts: New Jersey. https://www.census.gov/quickfacts/fact/table/NJ. Accessed 23 July 2021.

30.

Ene M, Leighton EA, Blue GL, Bell BA. Multilevel models for categorical data using SAS PROC GLIMMIX: the basics. https://support.sas.com/resources/papers/proceedings15/3430-2015.pdf.

31.

Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. Sage; 1999.

32.

Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the National Cancer Data Base. J Am Coll Surg. 2012;215(5):658–66. https://doi.org/10.1016/j.jamcollsurg.2012.07.008.CrossRefPubMed

33.

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. https://doi.org/10.1097/01.sla.0000197738.63512.23.CrossRefPubMedPubMedCentral

34.

Morrow M, Li Y, Alderman AK, et al. Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg. 2014;149(10):1015–21. https://doi.org/10.1001/jamasurg.2014.548.CrossRefPubMedPubMedCentral

35.

Knackstedt R, Adenuga P, Landreneau J, et al. The influence of social media on women undergoing immediate breast reconstruction. J Plast Reconstr Aesthet Surg JPRAS. 2019;72(5):848–62. https://doi.org/10.1016/j.bjps.2018.11.024.CrossRefPubMed

36.

Soon PS, Karimi N, Wu VS, Girgis A. Having breast reconstruction post-mastectomy: barriers and facilitators reported by Vietnamese-versus English-speaking women with breast cancer. Ethn Health. 2019;20:1–18. https://doi.org/10.1080/13557858.2019.1693513.CrossRef

37.

Zahedi S, Colvill K, Lopez M, Phillips LG. Implications of demographics and socioeconomic factors in breast cancer reconstruction. Ann Plast Surg. 2019;83(4):388–91. https://doi.org/10.1097/SAP.0000000000001919.CrossRefPubMed

38.

State of New Jersey Department of Health. New Jersey State Health Assessment Data: complete health indicator report of obesity among adults. https://www-doh.state.nj.us/doh-shad/indicator/complete_profile/Obese.html?ListCategoryFirst=x. Accessed 11 July 2021.

39.

Klinger EV, Carlini SV, Gonzalez I, et al. Accuracy of race, ethnicity, and language preference in an electronic health record. J Gen Intern Med. 2015;30(6):719–23. https://doi.org/10.1007/s11606-014-3102-8.CrossRefPubMed

Title: Impact of Patient Primary Language upon Immediate Breast Reconstruction After Mastectomy
Authors: Alison P. Woods, MD
Marianna V. Papageorge, MD
Susanna W. L. de Geus, MD, PhD
Andrea Alonso, MD
Andrea Merrill, MD
Michael R. Cassidy, MD
Daniel S. Roh, MD, PhD
Teviah E. Sachs, MD, MPH
David McAneny, MD
Frederick Thurston Drake, MD, MPH
Publication date: 06-08-2022
Publisher: Springer International Publishing
Keyword: Mastectomy
Published in: Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12354-x

At a glance: The STEP trials

Springer Medicine

Impact of Patient Primary Language upon Immediate Breast Reconstruction After Mastectomy

Abstract

Background

Patients and Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2022

Transgender and Non-binary Persons in Contemporary Oncology Randomized Clinical Trials

ASO Visual Abstract: Who Are We Missing: Does Engagement in Patient-Reported Outcome Measures for Breast Cancer Vary by Age, Race, and Disease Stage?

ASO Visual Abstract: Radiomics with Artificial Intelligence for the Prediction of Early Recurrence in Patients with Clinical Stage IA Lung Cancer

ASO Author Reflections: Is it Correct to Use 5% Dextrose Solution as a Carrier Fluid for Oxaliplatin-based HIPEC?

Trimming of Facial Artery Myomucosal Flap (FAMM) using Indocyanine Green Fluorescence Video-Angiography: Operative Nuances

Indications for Adjuvant Chemotherapy in Stage II Gastric Cancer After D2 Gastrectomy–A Chinese Multicenter Study