Abstract
Background
The literature examining decision-making related to treatment and reconstruction for women with breast cancer has established that patient, clinical, and facility factors all play a role.
Objectives
Using the National Cancer Database (NCDB), determine how patient, clinical, and facility factors influence: 1) the receipt of immediate breast reconstruction; and 2) the type of immediate breast reconstruction received (implant-based, autologous, or a combination).
Methods
A total of 638,772 female patients with TIS-T3, N0-N1, M0 breast cancers were identified in the NCDB from 2004-2017 who received immediate reconstruction following mastectomy. Univariate and multivariable logistic regression models were conducted to identify characteristics associated with immediate breast reconstruction and type of reconstruction.
Results
Immediate breast reconstruction was more frequently associated with patients of white race, younger age, with private insurance, with lesser comorbidities, who resided in zip-codes with higher median incomes or higher rate of high-school graduation, in urban areas, with Tis-T2 disease, or with <4 lymph node involvement (all odds ratios (OR) > 1.1). Negative predictors of immediate breast reconstruction were insurance status with Medicaid, Medicare, other government insurance, and none or unknown insurance (all ORs <0.79). Implant-based reconstruction was associated with non-black race, uninsured status, completion of higher education, undifferentiated disease, and stage T0 disease (all ORs >1.10).
Conclusions
These findings confirm some previous studies on what patient, clinical, and facility factors affect decision making, but also raise new questions that relate to the impact of third-party payor on receipt and type of reconstruction post-mastectomy for breast cancer.
National study of the impact of patient information and involvement in decision-making on immediate breast reconstruction rates