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abstract
Highlights
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- Significant variation exists between specialties for beliefs toward breast reconstruction.
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- Many believe reconstruction interferes with recurrence detection and delays adjuvant therapy.
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- Results disagree with Cancer Care Ontario guidelines.
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- Many believe delays are due to insufficient health care resources in Ontario.
Background
The
purpose of this study was to characterize beliefs and practice patterns
for breast cancer reconstruction among physicians who treat patients
with breast cancer, in order to delineate current clinical practice.
This survey was administered prior to Cancer Care Ontario guideline
publication.
Method
Survey
questions addressed four domains: survival, delayed or obscured
recurrence detection, delayed adjuvant therapy, and aesthetics. The
survey was administered to 1160 Ontario plastic and general surgeons and
radiation and medical oncologists. Data were compared to published
guidelines.
Results
The
overall response rate was 48%, with 57% of respondents treating breast
cancer. Of those treating breast cancer, 75% are affiliated with an
academic center. Immediate breast reconstruction (IBR) is not available
to 28%. Autologous reconstruction is thought to interfere with
recurrence detection by 23% (oncologists 30%, surgeons 19%, p = 0.04).
For patients not expected to require radiation therapy, IBR is not
supported by 30%. Autologous IBR is believed to delay delivery of
adjuvant chemotherapy by 45% (oncologists 55%, surgeons 41%, p = 0.02).
Up to 42% of respondents believe delays in adjuvant therapy delivery
following IBR are due to insufficient health care resources (ie.
coordinating an oncologic and reconstructive surgeon). Radiation therapy
following reconstruction is believed to have negative aesthetic
outcomes, and increase the need for revision surgery.
Conclusions
Unfavourable
beliefs about certain clinical actions do not align with recent
provincial guideline recommendations. Insufficient healthcare resources
are perceived to be a significant barrier to IBR and timely care.
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