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Supportive Care in Cancer

, Volume 27, Issue 6, pp 2135–2142 | Cite as

Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer

  • P. S. SoonEmail author
  • S. Ruban
  • H. T. J. Mo
  • R. Lee
  • L. Saliba
  • A. Shah
  • D. Segara
  • S. Yarrow
  • A. Girgis
Original Article

Abstract

Purpose

In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%.

This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women’s reconstruction decisions.

Methods

Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic).

Results

Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction.

Conclusions

Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients’ decisions about breast reconstruction, especially for non-English speaking patients.

Keywords

Breast cancer Breast reconstruction CALD Mastectomy 

Notes

Acknowledgements

The authors gratefully acknowledge the assistance of Joseph Descallar with statistical analysis.

Funding information

Funding for this project was through the South Western Sydney Local Health District Mid-Career Research Grant Support to PSS, and AG is funded through Cancer Institute NSW grants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ferlay J et al (2013) Cancer Incidence and Mortality Worldwide: IARC CancerBase. In: GLOBOCAN 2012 (online). International Agency for Research on Cancer, LyonGoogle Scholar
  2. 2.
    AIHW (2016) Australian Cancer Incidence and Mortality (ACIM) books: breast cancer. AIHW, CanberraGoogle Scholar
  3. 3.
    Kwok C, White K (2011) Cultural and linguistic isolation: the breast cancer experience of Chinese-Australian women - a qualitative study. Contemp Nurse 39(1):85–94CrossRefGoogle Scholar
  4. 4.
    Boehmke MM, Dickerson SS (2005) Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nurs 28(5):382–389CrossRefGoogle Scholar
  5. 5.
    Ditsch N, Bauerfeind I, Vodermaier A, Tripp C, Löhrs B, Toth B, Himsl I, Graeser M, Harbeck N, Lenhard M (2013) A retrospective investigation of women’s experience with breast reconstruction after mastectomy. Arch Gynecol Obstet 287:555–561CrossRefGoogle Scholar
  6. 6.
    National Breast and Ovarian Cancer Centre (2010) National Breast and Ovarian Cancer Centre and Royal Australasian College of Surgeons National Breast Cancer Audit Public Health Monitoring Series 2008 Data. National Breast and Ovarian Cancer Centre, Surry HillsGoogle Scholar
  7. 7.
    Kocan S, Gursoy A (2016) Body image of women with breast cancer after mastectomy: a qualitative research. J Breast Health 12:145–150CrossRefGoogle Scholar
  8. 8.
    Reuben BC, Manwaring J, Neumayer LA (2009) Recent trends and predictors in immediate breast reconstruction after mastectomy in the United States. Am J Surg 198(2):237–243CrossRefGoogle Scholar
  9. 9.
    Cordeiro PG (2008) Breast reconstruction after surgery for breast cancer. N Engl J Med 359(15):1590–1601CrossRefGoogle Scholar
  10. 10.
    Eriksen C, Frisell J, Wickman M, Lidbrink E, Krawiec K, Sandelin K (2011) Immediate reconstruction with implants in women with invasive breast cancer does not affect oncological safety in a matched cohort study. Breast Cancer Res Treat 127(2):439–446CrossRefGoogle Scholar
  11. 11.
    Heneghan HM, Prichard RS, Lyons R, Regan PJ, Kelly JL, Malone C, McLaughlin R, Sweeney KJ, Kerin MJ (2011) Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery. Eur J Surg Oncol 37(11):937–943CrossRefGoogle Scholar
  12. 12.
    Mustonen P et al (2004) The surgical and oncological safety of immediate breast reconstruction. Eur J Surg Oncol 30(8):817–823CrossRefGoogle Scholar
  13. 13.
    Handel N, Silverstein MJ, Waisman E, Waisman JR (1990) Reasons why mastectomy patients do not have breast reconstruction. Plast Reconstr Surg 86(6):1118–1122CrossRefGoogle Scholar
  14. 14.
    Platt J, Baxter N, Zhong T (2011) Breast reconstruction after mastectomy for breast reconstruction. Can Med Assoc J 183(18):2109–2116CrossRefGoogle Scholar
  15. 15.
    Schain WS, Jacobs E, Wellisch DK (1984) Psychosocial issues in breast reconstruction. Intrapsychic, interpersonal, and practical concerns. Clin Plast Surg 11(2):237–251Google Scholar
  16. 16.
    Schain WS et al (1985) The sooner the better: a study of psychological factors in women undergoing immediate versus delayed breast reconstruction. Am J Psychiatry 142(1):40–46CrossRefGoogle Scholar
  17. 17.
    Lam TC, Winch CJ (2016) What would women choose when given a choice in breast reconstruction?. Plastic and reconstructive surgery. Global Open 4(9):e1062Google Scholar
  18. 18.
    Flitcroft K et al (2016) Documenting patterns of breast reconstruction in Australia: the national picture. Breast 30:47–53CrossRefGoogle Scholar
  19. 19.
    Jeevan R, Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury RM, Cromwell DA (2016) National trends and regional variation in immediate breast reconstruction rates. Br J Surg 103(9):1147–1156CrossRefGoogle Scholar
  20. 20.
    Chiu AS, Thomas P, Killelea BK, Horowitz N, Chagpar AB, Lannin DR (2017) Regional variation in breast cancer surgery: results from the National Cancer Database (NCDB). Am J Surg 214(5):907–913CrossRefGoogle Scholar
  21. 21.
    Wong A et al (2014) Increasing breast reconstruction rates by offering more women a choice. Breast 84:31–36Google Scholar
  22. 22.
    Lee C, Hultman C, Sepucha K (2010) What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg 64(5):567–569Google Scholar
  23. 23.
    Manne S, Topham N, D'Agostino TA, Myers Virtue S, Kirstein L, Brill K, Manning C, Grana G, Schwartz MD, Ohman-Strickland P (2015) Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psycho-Oncology 25(12):1424–1433CrossRefGoogle Scholar
  24. 24.
    Murray CD, Turner A, Rehan C, Kovacs T (2015) Satisfaction following immediate breast reconstruction: experiences in the early post-operative stage. Br J Health Psychol 20(3):579–593CrossRefGoogle Scholar
  25. 25.
    Sepucha KR, Fowler FJ Jr, Mulley AG Jr (2004) Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Aff Suppl Variation: VAR54–62Google Scholar
  26. 26.
    Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women revisit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefGoogle Scholar
  27. 27.
    Hequet D et al (2013) Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus 2:325CrossRefGoogle Scholar
  28. 28.
    Cancer Australia (2016) Cancer Australia Statement - Influencing best practice in breast cancer. Cancer Australia, Surry HillsGoogle Scholar
  29. 29.
    National_Institute_for_Health_and_Care_Excellence (2009) Early and locally advanced breast cancer: diagnosis and treatment. NICE guidelines [CG80]. National Collaborating Centre for Cancer, CardiffGoogle Scholar
  30. 30.
    Morrow M, Scott SK, Menck HR, Mustoe TA, Winchester DP (2001) Factors influencing the use of breast reconstruction postmastectomy: a national cancer database study. J Am Coll Surg 192(1):1–8CrossRefGoogle Scholar
  31. 31.
    Desch CE, Penberthy LT, Hillner BE, McDonald MK, Smith TJ, Pozez AL, Retchin SM (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy and conservative surgery. Surgery 125(4):441–447CrossRefGoogle Scholar
  32. 32.
    Polednak AP (2001) How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plast Reconstr Surg 108:73–77CrossRefGoogle Scholar
  33. 33.
    Polednak AP (1999) Postmastectomy breast reconstruction in Connecticut: trends and predictors. Plast Reconstr Surg 104(3):669–673CrossRefGoogle Scholar
  34. 34.
    South Western Sydney Local Health District, SWSLHD year in review 2015/2016. 2016Google Scholar
  35. 35.
    Alderman AK, Hawley ST, Morrow M, Salem B, Hamilton A, Graff JJ, Katz S (2011) Receipt of delayed breast reconstruction after mastectomy: do women visit the decision? Ann Surg Oncol 18(6):1748–1756CrossRefGoogle Scholar
  36. 36.
    Alderman AK, Hawley ST, Janz NK, Mujahid MS, Morrow M, Hamilton AS, Graff JJ, Katz SJ (2009) Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population-based study. J Clin Oncol 27(32):5325–5330CrossRefGoogle Scholar
  37. 37.
    Morrow M, Li Y, Alderman AK, Jagsi R, Hamilton AS, Graff JJ, Hawley ST, Katz SJ (2014) Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg 149(10):1015–1021CrossRefGoogle Scholar
  38. 38.
    Bell RJ, Robinson PJ, Fradkin P, Schwarz M, Davis SR (2012) Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia. Breast J 21(3):394–400Google Scholar
  39. 39.
    Ng SK, Hare RM, Kuang RJ, Smith KM, Brown BJ, Hunter-Smith DJ (2016) Breast reconstruction post mastectomy: patient satisfaction and decision making. Ann Plast Surg 76(6):640–644CrossRefGoogle Scholar
  40. 40.
    Flitcroft K, Brennan M, Spillane A (2017) Decisional regret and choice of breast reconstruction following mastectomy for breast cancer: a systematic review. PsychooncologyGoogle Scholar
  41. 41.
    Smith A, Agar M, Delaney G, Descallar J, Dobell-Brown K, Grand M, Aung J, Patel P, Kaadan N, Girgis A (2018) Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers. Asia Pac J Clin Oncol 14(1):52–60Google Scholar
  42. 42.
    Meiser B, Kaur R, Zilliacus E, Wong T, Woodland L, Tomkins S, Kissane D, Girgis A, Butow P, Hale S, Perry A, Aranda SK, Shaw T, Tebble H, Goldstein D (2017) Evaluation of an online communications skills training programme for oncology health care professionals working with patients from minority backgrounds. Asia Pac J Clin Oncol 13:66Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryBankstown HospitalBankstownAustralia
  2. 2.South Western Sydney Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.Centre for Oncology Education and Research TranslationIngham Institute for Applied Medical ResearchLiverpoolAustralia
  4. 4.Department of SurgeryFairfield HospitalPrairiewoodAustralia
  5. 5.Department of SurgeryLiverpool HospitalLiverpoolAustralia

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