Influence of socioeconomic status on immediate breast reconstruction rate, patient information and involvement in surgical decision‐making

• Published in: BJS open Vol. 4; no. 2; pp. 232 - 240
• Main Authors: Frisell, A., Lagergren, J., Halle, M., Boniface, J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.04.2020; Oxford University Press
• Subjects: Adult; Age; Aged; Aged, 80 and over; Breast; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Cancer surgery; Cohort Studies; Decision Making; Education; Female; Humans; Income; Logistic Models; Mammaplasty - statistics & numerical data; Mastectomy; Mastectomy - statistics & numerical data; Medicin och hälsovetenskap; Middle Aged; Multivariate Analysis; Original; Patient Participation; Plastic surgery; Questionnaires; Radiation therapy; Registries; Social Class; Socioeconomic factors; Socioeconomic status; Surveys and Questionnaires; Sweden - epidemiology; Womens health; Young Adult; Sweden; United States > US; Europe
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1002/bjs5.50260

Background Immediate breast reconstruction (IBR) rates in breast cancer differ between healthcare regions in Sweden. This is not explained by regional differences in patient age distribution or tumour characteristics, but by differences in patient‐reported information and patient involvement in the decision‐making process. As socioeconomic status may play a significant role in surgical decision‐making, its potential associations with IBR rates were analysed. Methods Women who had undergone therapeutic mastectomy for primary breast cancer in Sweden in 2013 were included in the analysis. Tumour and treatment data were retrieved from the Swedish National Breast Cancer Register, and socioeconomic background data from the Central Bureau of Statistics Sweden. Postal questionnaires regarding information about reconstruction and perceived involvement in the preoperative decision‐making process had been sent out in a previous survey. Results In addition to regional differences, lower tumour and nodal category, independent factors increasing the likelihood of having IBR for the 3131 women in the study were living without a registered partner, having current employment and high income per household. Patient‐reported perceived preoperative information (odds ratio (OR) 12·73, 95 per cent c.i. 6·03 to 26·89) and the feeling of being involved in the decision‐making process (OR 2·56, 1·14 to 5·76) remained strong independent predictors of IBR despite adjustment for socioeconomic factors. Importantly, responders to the survey represented a relatively young and wealthy population with a lower tumour burden. Conclusion Several socioeconomic factors independently influence IBR rates; however, patient‐reported information and involvement in the surgical decision‐making process remain independent predictors for the likelihood of having IBR. Antecedentes El carcinoma hepatocelular con trombo tumoral (TT) en la vena cava inferior (inferior vena cava, IVC) o en la aurícula derecha (right atrium, RA) es un estado avanzado de la enfermedad raro, con un pronóstico desfavorable. En este estudio analizamos la supervivencia después de la resección quirúrgica. Métodos Se incluyeron pacientes con carcinoma hepatocelular con TT en la IVC o en la RA, que se sometieron a resección hepática entre febrero de 1997 y julio de 2017. Los resultados a corto y a largo plazo de estos pacientes y los detalles quirúrgicos se analizaron retrospectivamente. Resultados Se incluyeron 37 pacientes. Entre estos pacientes, se identificaron 16 pacientes con TT en la IVC infradiafragmática, 8 pacientes con TT en la IVC supradiafragmática y 13 pacientes con TT entrando en la AR. Doce pacientes asociaron TT avanzado en la vena porta más allá de vp 3 y 4, 10 pacientes tenían enfermedad bilobar y 12 pacientes tenían enfermedad extrahepática. A pesar de que la tasa de mortalidad hospitalaria fue cero, dos pacientes fallecieron a los 90 días. Aunque la mediana del tiempo de supervivencia no fue diferente entre el grupo al que se le realizó resección con intención curativa (18,7 meses) y aquellos con tumor residual solo en el pulmón (20,7 meses), la supervivencia fue extremadamente pobre para los pacientes con tumor residual en el hígado (8,3 meses). Conclusión La resección hepática con trombectomía para el carcinoma hepatocelular avanzado con trombo tumoral en la vena cava inferior o en la aurícula derecha es segura y factible, asociándose a una supervivencia moderada. Socioeconomic factors independently influence immediate breast reconstruction rates in Sweden. Patient‐reported information and involvement in the surgical decision‐making process remain independent predictors of the likelihood of undergoing immediate breast reconstruction. Low income reduces immediate breast reconstruction