Documenting patterns of breast reconstruction in Australia: The national picture

Kanesalingam

et al. 2019

Background Australia has a large population of immigrant women from Arabic‐speaking countries. The aim of this study was to examine breast cancer tumour and surgical treatment features for women born in Arabic‐speaking countries and compare them to women born in Australia and other countries. Another aim was to consider how this information can inform clinical care for this multicultural population. Methods This is a retrospective audit of an institutional breast cancer database. Demographic, tumour and surgical treatment data were extracted for the Arab women and compared to Australian‐born women (comparison 1) and to women born in all other countries (comparison 2); chi‐squared analysis was performed to test for differences between groups. Results A total of 2086 cases with country of birth information were identified, of whom 139 women (6.7%) were born in Arabic‐speaking countries, 894 (42.8%) were born in Australia and 1053 (50.4%) were born in other countries (71 nations). Arab women tended to be younger (P = 0.013), more disadvantaged (P < 0.001), were more likely to have symptomatic rather than screen‐detected breast cancer (P < 0.001), had a higher rate of high grade (P = 0.021), HER2‐positive (P = 0.025) breast cancer compared to Australian‐born women or others. There was no difference in tumour (pT) stage, rate of breast conservation versus mastectomy, re‐excision and contralateral prophylactic mastectomy between groups. Australian‐born women were more likely to undergo breast reconstruction after mastectomy (P < 0.001); reconstruction rate was >29% in all groups. Conclusion Women born in Arabic‐speaking countries were younger, more disadvantaged and showed more aggressive tumour features. This has implications for supportive care during treatment and survivorship.

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Presentation, tumour and treatment features in immigrant women from Arabic‐speaking countries treated for breast cancer in Australia

Heilat

Kanesalingam

et al. 2019

“…This may in some circumstances be due to lack of available human and other resources to provide such a service, but as our interviews have shown, all too often seems to be a result of different combinations of the following issues: wanting to ‘own’ the patient's management by framing management recommendations to suit the individual surgeon's skill set, bias, lack of professional respect, lack of open communication or a paternalistic view of what is best for the patient. A designated referral pathway has been suggested as a possible means of promoting informed discussion and patient choice . Implementation of this pathway would be challenging, requiring the education of all stakeholders and support from the relevant professional societies, to be feasible and translatable.…”

Section: Discussionmentioning

confidence: 99%

“…In this environment of trained OBS surgeons, plastic surgeon colleagues may receive fewer referrals for patients who prefer non-autologous BR, although plastic surgeons are still the only surgeons trained in micro-vascular anastomosis techniques required for free flap BR. Against this background, the current national rate of BR is low (around 18%) 4 compared to other western countries and a substantial increase in this rate would stretch the existing traditional workforce capacity.…”

Section: Introductionmentioning

confidence: 98%

On the frontiers of change: breast surgeons' views on demarcation between surgical sub‐specialties in Australia

Flitcroft

Spillane

2019

Self Cite

Background The emergence of breast oncoplastic surgery provides women with more surgical options for improved aesthetics following breast‐conserving surgery and for breast reconstruction (BR) following mastectomy. For some established breast and plastic surgeons, this development may be perceived as increasing competition for patients and raises the potential for demarcation issues between and within surgical sub‐specialties. The objectives of the study were to document surgeons' views on demarcation between general/breast, oncoplastic/breast and plastic reconstructive breast surgeons in Australia, to examine the potential impact demarcation issues may have on informed patient choice and to recommend ways of reducing them. Methods In‐depth qualitative interviews were conducted with a convenience sample of 31 (22 oncoplastic and nine plastic reconstructive) surgeons who performed BR. Results Descriptive analysis of the interviews revealed a range in the perceptions of the extent of demarcation. Six common themes were identified: oncoplastic techniques are unnecessary and potentially unsafe; reconstructive surgery should be left to ‘the experts’; non‐referral of patients for discussion of surgical options they do not offer; professional jealousy; workload capacity; and the old versus the new guard. Potential solutions suggested by the participants focused on improving relations between oncoplastic and plastic reconstructive surgeons and changes to breast surgical training. Conclusion While most surgeons were optimistic about the current divide diminishing with time, a more pro‐active stance is required if patient‐centred care is to be improved. Roundtable discussions with a broad range of stakeholders are planned to begin this process.

“…This has led to an increased focus on maximizing the long-term quality of life (QoL) of patients. [5][6][7] For example, an audit of UK surgeons found 'a significant proportion' of older women were not offered immediate BR (IBR), regardless of their clinical suitability. 3,4 Despite this, the rate of BR remains low in patients aged 60 years and older.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of breast reconstruction in older women: patterns of uptake and clinical outcomes in a large metropolitan practice

Flitcroft

et al. 2019

Self Cite

Background: Older age is associated with lower rates of breast reconstruction (BR) following mastectomy. This study compared a range of factors in women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). Methods: An audit of 338 women aged 60 or over treated with mastectomy with (n = 86) or without (n = 252) BR for primary breast cancer from 2009 to 2016 was conducted. Demographic, tumour, treatment, comorbidity and surgical complication data were obtained from patient medical records. Results: NBR patients were associated with older age (P ≤ 0.001), more comorbidities (P = 0.038) and more extensive disease (P = 0.001) than BR patients. Total number of complications was not significantly different between BR and NBR patients (P = 0.286), or the different types of BR (P = 0.697). BR patients had higher rates of unplanned returns to the operating theatre, particularly in the late post-operative period (P = 0.025). Implant-based reconstruction was associated with more unplanned operating theatre returns than autologous reconstruction in the late post-operative period (P = 0.013). Conclusion: Post-mastectomy BR in elderly patients has a clinical complication profile similar to NBR patients. This audit found no clinical-based reasons to not offer oncologically suitable and clinically fit elderly women the option of BR.