Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

Greenberg, Caprice C.; Schneider, Eric C.; Lipsitz, Stuart R.; Ko, Clifford Y.; Malin, Jennifer L.; Epstein, Arnold M.; Weeks, Jane C.; Kahn, Katherine L.

doi:10.1016/j.jamcollsurg.2007.11.017

Cited by 94 publications

(92 citation statements)

References 39 publications

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“…Older patients were found to be more likely to choose mastectomy alone than reconstruction. 35 Provider bias, however, may also be a contributing factor: older and nonwhite patients were less likely than younger women and white women to receive information about breast reconstruction, 36 and nonwhite women are more likely than white women to be discouraged from breast reconstruction. 33,34 Cancer-related factors The stage of cancer and adjuvant therapies, such as radiation therapy, affect the rate of reconstruction after mastectomy.…”

Section: Patient Preferencementioning

confidence: 99%

Breast reconstruction after mastectomy for breast cancer

Platt¹,

Baxter²,

Zhong³

2011

Canadian Medical Association Journal

100

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Review CMAJ• Breast reconstruction after mastectomy is an oncologically safe procedure that can improve psychosocial outcomes.• Increased age, nonwhite ethnic background, low income and nonurban residence are associated with decreased rates of breast reconstruction.• Physician perceptions and knowledge, as well as cancer stage, also influence the rate of this procedure.• Mastectomy with immediate breast reconstruction should be presented to patients with in situ or early stage breast cancer as an option along with breast-conservation therapy and mastectomy alone.

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Section: Patient Preferencementioning

confidence: 99%

Breast reconstruction after mastectomy for breast cancer

Platt¹,

Baxter²,

Zhong³

2011

Canadian Medical Association Journal

100

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show abstract

“…In particular, preferences will depend on the information women are given about immediate reconstruction and it has been shown that clinicians are less likely to discuss reconstruction with women from deprived backgrounds. 17,18 Second, post-mastectomy radiotherapy use varies across Networks. 2 Radiotherapy may impair the aesthetic outcomes of immediate reconstruction and women who are expected to M A N U S C R I P T …”

Section: Sources Of Regional Variationmentioning

confidence: 99%

Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England

Jeevan

Cromwell

Browne

et al. 2010

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Conclusions: There is substantial regional variation in immediate reconstruction use inEngland that is not explained by the characteristics of the local patient population. EnglishCancer Networks should act to reduce this variation. They should also examine why rates of reconstruction differ between particular patient groups.

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“…20 In a population-based study of women with breast cancer, Morrow et al found that the majority of women (78.2%) reported discussion of breast reconstruction with their physician and found no significant differences in the rate of these discussions based on race or study site. 2,21 In contrast, Greenberg et al found that patients who were younger, more educated, and not receiving radiation were more likely to have a discussion regarding reconstructive surgery. 21 The objectives of this study are (1) to examine sociodemographic variations in physician-patient discussion of breast reconstruction and (2) to explore the impact of physician-patient discussion on the use of this procedure.…”

Section: Introductionmentioning

confidence: 97%

“…2,21 In contrast, Greenberg et al found that patients who were younger, more educated, and not receiving radiation were more likely to have a discussion regarding reconstructive surgery. 21 The objectives of this study are (1) to examine sociodemographic variations in physician-patient discussion of breast reconstruction and (2) to explore the impact of physician-patient discussion on the use of this procedure.…”

Section: Introductionmentioning

confidence: 97%

Variation in Physician-patient Discussion of Breast Reconstruction

et al. 2008

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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.KEY WORDS: breast reconstruction; decision-making; low income.

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Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

Cited by 94 publications

References 39 publications

Breast reconstruction after mastectomy for breast cancer

Breast reconstruction after mastectomy for breast cancer

Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England

Variation in Physician-patient Discussion of Breast Reconstruction

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