Alderman Amy K, Hawley Sarah T, Waljee Jennifer, Mujahid Mahasin, Morrow Monica, Katz Steven J
Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0340, USA.
Cancer. 2008 Feb 1;112(3):489-94. doi: 10.1002/cncr.23214.
Reconstruction is rarely incorporated into the decision-making process for surgical breast cancer treatment. We examined the importance of knowing about reconstruction to patients' surgical decision-making for breast cancer.
We surveyed women aged < or =79 years with breast cancer (N = 1844) who were reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries (response rate, 77.4%). The dependent variables were 1) patients' report of having a discussion about breast reconstruction with their general surgeon (yes/no), 2) whether or not this discussion had an impact on their willingness to be treated with a mastectomy (yes/no), and 3) whether the patient received a mastectomy (yes/no). The independent variables included age, race, education, tumor size, tumor behavior, and presence of comorbidities. Chi-square, Student t test, and logistic regression were used for analyses.
Only 33% of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients with larger tumors. Knowing about reconstructive options significantly increased patients' willingness to consider a mastectomy (OR, 2.06; P <.01). In addition, this discussion influenced surgical treatment. Patients who discussed reconstruction with their general surgeon were 4 times more likely to receive a mastectomy compared with those who did not (OR, 4.48; P < .01).
Most general surgeons do not discuss reconstruction with their breast cancer patients before surgical treatment. When it occurs, this discussion significantly impacts women's treatment choice, making many more likely to choose mastectomy. This highlights the importance of multidisciplinary care models to facilitate an informed surgical treatment decision-making process.
重建很少被纳入乳腺癌手术治疗的决策过程。我们研究了了解重建对患者乳腺癌手术决策的重要性。
我们对年龄小于或等于79岁的乳腺癌女性（N = 1844）进行了调查，这些女性被上报至底特律和洛杉矶监测、流行病学及最终结果（SEER）癌症登记处（应答率为77.4%）。因变量包括：1）患者报告其与普通外科医生讨论过乳房重建（是/否）；2）该讨论是否影响了她们接受乳房切除术的意愿（是/否）；3）患者是否接受了乳房切除术（是/否）。自变量包括年龄、种族、教育程度、肿瘤大小、肿瘤行为以及合并症的存在情况。采用卡方检验、学生t检验和逻辑回归进行分析。
只有33%的患者在癌症手术决策过程中有普通外科医生与她们讨论乳房重建。外科医生与年龄较小、受教育程度较高且肿瘤较大的患者进行这种讨论的可能性显著更高。了解重建选择显著增加了患者考虑乳房切除术的意愿（比值比[OR]，2.06；P <.01）。此外，这种讨论影响了手术治疗。与未与普通外科医生讨论重建的患者相比，与普通外科医生讨论过重建的患者接受乳房切除术的可能性高出4倍（OR，4.48；P <.01）。
大多数普通外科医生在手术治疗前未与乳腺癌患者讨论重建问题。当进行这种讨论时，它会显著影响女性的治疗选择，使更多女性更有可能选择乳房切除术。这凸显了多学科护理模式对促进明智的手术治疗决策过程的重要性。
