Abstract
Background
: The objective is to determine perspectives of general surgeons, plastic surgeons,
and cancer navigators on factors contributing to breast cancer patients’ decision
for post-mastectomy reconstruction, especially for women facing financial hardship.
Methods
: We mailed Wisconsin general and plastic surgeons who performed >5 breast cancer
procedures annually a survey, including a postcard inviting cancer navigators to participate.
Descriptive statistics summarize item responses. McNemar's chi-squared tests evaluated
surgeons’ perspectives of factors influencing reconstruction for all women compared
to women facing financial hardship.
Results
: Respondents include 70 general surgeons, 18 plastic surgeons, and 9 navigators.
Respondents perceived preference-related factors as important, including “does not
want more surgery” (85% reported it important overall and 77% for financial hardship
women) and “reconstructed breast is not important to her” (77% vs. 61%). Surgeons
perceived logistical factors were more important for women facing financial hardship,
including “capacity to be away from work or home responsibilities for recovery” (30%
reported important overall and 60% for financial hardship women), “concerned about
out-of-pocket costs” (26% vs. 57%), and “frequent visits to complete reconstruction
too burdensome” (27% vs. 49%).
Conclusion
: Our findings demonstrate Wisconsin surgeons and cancer navigators perceive logistical
concerns influence reconstruction decisions for women facing financial hardship.
Clinical Practice Points
: Rates of post-mastectomy breast reconstruction have increased over the past decade.
However, disparities in the receipt of reconstruction still exist, especially for
socioeconomically disadvantaged women. In order to understand these disparities, one
must first understand the upstream factors affecting the ultimate decision for reconstruction.
Clinical stakeholders, play major roles in the decision-making process of patients
contemplating breast surgery. We examined the perspectives of general surgeons, plastic
surgeons, and cancer navigators in the state of Wisconsin on factors that contribute
to whether or not breast cancer patients considering mastectomy subsequently undergo
breast reconstruction, specifically focusing on women who are socioeconomically disadvantaged.
Our study demonstrated that surgeons perceive preference-related factors as important
determinants, including “does not want more surgery” (85% reported it important overall
and 77% for financial hardship women) and “reconstructed breast is not important to
her” (77% vs. 61%). Importantly, surgeons perceived logistical factors were more important
for women facing financial hardship, including “capacity to be away from work or home
responsibilities for recovery” (30% reported important overall and 60% for financial
hardship women), “concerned about out-of-pocket costs” (26% vs. 57%), and “frequent
visits to complete reconstruction too burdensome” (27% vs. 49%). Our respondents identified
potential opportunities to reduce disparities, including improving processes for referral
or facilitating the peri-operative care for patients who must travel for reconstruction,
improving patient education about reconstruction options when they meet with a general/breast
surgeon (i.e. educational videos), and educating surgeons acceptable delays between
diagnosis and surgery to allow for coordination of reconstruction.
Keywords
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Article Info
Publication History
Accepted:
July 22,
2022
Received in revised form:
July 20,
2022
Received:
June 27,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
