基于现代人群乳腺癌患者队列的知识、交流和接受乳房重建模式及其相关因素。
Patterns and Correlates of Knowledge, Communication, and Receipt of Breast Reconstruction in a Modern Population-Based Cohort of Patients with Breast Cancer.
机构信息
From the Section of Plastic Surgery, the School of Public Health, Center for Cancer Biostatistics, the Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, and the Department of Internal Medicine, Department of Health Management and Policy, University of Michigan; the Ann Arbor U.S. Department of Veterans Affairs Health Services Research and Development; the Department of Surgery, Memorial Sloan Kettering Cancer Center; the Department of Epidemiology, Rollins School of Public Health, Emory University; and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California.
出版信息
Plast Reconstr Surg. 2019 Aug;144(2):303-313. doi: 10.1097/PRS.0000000000005803.
BACKGROUND
Disparities persist in the receipt of breast reconstruction after mastectomy, and little is known about the nature of communication received by patients and potential variations that may exist.
METHODS
Women with early-stage breast cancer (stages 0 to II) diagnosed between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries and surveyed to collect additional data on demographics, treatment, and decision-making experiences. Treating general/oncologic surgeons were also surveyed. Primary outcomes measures included self-reported communication-related measures on receipt of information on breast reconstruction and on the receipt of breast reconstruction.
RESULTS
The authors analyzed 936 women who underwent mastectomy for unilateral breast cancer. Four hundred eighty-four (51.7 percent) underwent mastectomy with reconstruction. Women who were older and for whom English was not their primary spoken language had lower odds of being informed by a doctor about breast reconstruction. Ultimately, women who were older, were Asian, had invasive disease, had bronchitis/emphysema, and had lower income were less likely to undergo breast reconstruction. Breast reconstruction was performed more often in patients undergoing bilateral mastectomies (OR, 3.27; 95 percent CI, 2.26 to 4.75). Women cared for by surgeons with higher volumes of breast cancer patients (≥51 patients per year) were more likely to undergo breast reconstruction (OR, 2.43; 95 percent CI, 1.40 to 4.20).
CONCLUSION
To eliminate existing disparities, increased efforts should be made in consultations for surgical management of breast cancer to provide information to all patients regarding the option of breast reconstruction, the possibility of immediate reconstruction, and insurance coverage of all stages of reconstruction.
背景
在接受乳房重建手术后，仍存在差异，而对于患者所接受的沟通性质以及可能存在的差异，人们知之甚少。
方法
通过佐治亚州和洛杉矶监测、流行病学和结果登记处，确定了 2013 年 7 月至 2014 年 9 月期间诊断为早期乳腺癌（0 期至 2 期）的女性，并对其进行了调查，以收集有关人口统计学、治疗和决策经验的其他数据。还对治疗的普通/肿瘤外科医生进行了调查。主要结果衡量标准包括接受乳房重建信息和接受乳房重建的自我报告的沟通相关措施。
结果
作者分析了 936 名接受单侧乳腺癌乳房切除术的女性。其中 484 名（51.7%）接受了乳房切除术加重建。年龄较大且英语不是其主要语言的女性，医生告知其乳房重建的可能性较低。最终，年龄较大、为亚洲人、患有浸润性疾病、患有支气管炎/肺气肿以及收入较低的女性，接受乳房重建的可能性较低。接受双侧乳房切除术的患者（OR，3.27；95%CI，2.26 至 4.75）进行乳房重建的情况更为常见。由乳腺癌患者就诊量较高（≥51 例/年）的外科医生治疗的女性，更有可能接受乳房重建（OR，2.43；95%CI，1.40 至 4.20）。
结论
为消除现有差异，在乳腺癌手术管理的咨询中应加大力度，向所有患者提供有关乳房重建选择、即刻重建的可能性以及所有重建阶段的保险覆盖的信息。
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