Breaking Barriers to Breast Reconstruction among Socioeconomically Disadvantaged Patients at a Large Safety-net Hospital

Abstract

Background: Socioeconomic disparities remain prevalent among those who undergo breast reconstruction. At our institution, patients must meet certain criteria to become eligible for breast reconstruction. The purpose of this study was to determine the impact of socioeconomic factors on breast reconstruction eligibility, enrollment, choice, and completion at our large safety-net institution. Methods: A retrospective chart review of patients who underwent partial or total mastectomy at a large safety-net hospital from 2016 to 2019 was completed. Surgical and demographic data were compared across varying socioeconomic factors. Results: A total of 645 patients were included in the study. More patients of a racial minority had government-based insurance than White patients (89% versus 81%; P = 0.01). Those with government-based insurance had higher average hemoglobin A1c values (6.26 versus 6.0; P = 0.03), proportion of American Society of Anesthesiologists scores greater than III (46% versus 40%; P = 0.01), and smokers (23% versus 9%; P = 0.02) than those with private insurance. Diabetic patients, patients with an American Society of Anesthesiologists greater than III, and active smokers were significantly less likely to receive a plastic surgery consult. Patients with government-based insurance underwent immediate tissue expander placement at mastectomy at rates lower than those with private insurance (57% versus 69%; P = 0.01). Conclusions: Barriers remain for socioeconomically disadvantaged patients to be eligible for, undergo, and complete breast reconstruction. Obesity, diabetes, smoking, and poor overall health were identified as the main barriers and were associated with racial minorities, government-based insurance, and lower incomes. Concerted effort through multidisciplinary teams is needed to maximize eligibility of socioeconomically disadvantaged breast cancer patients for reconstruction.

Psychological impact of the COVID-19 pandemic on breast cancer patients

“…This is a decreased overall trend compared with the institution’s historical data from 2016 to 2019, which showed a breast reconstruction rate of 66%. 20 In addition, more patients within the surge group stated that they did not see a plastic surgeon for a consult following their diagnosis compared with survey participants from the nonsurge group, although referral rates between the two groups remained similar.…”

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

“…10 Research has since attempted to elucidate whether insurance status continues to impact the reconstructive course. [11][12][13][14][15][16][17][18][19][20] Many of these studies have assessed the influence of insurance status on the modality of breast reconstruction as well as clinical outcomes, but little is known about how insurance status -and by extension, SDOH -can affect PROs. Assessing the impact of SDOH on PROs after breast reconstruction is critical to ensure that all patients are satisfied and have optimal quality of life.…”