Receipt of Delayed Breast Reconstruction After Mastectomy: Do Women Revisit the Decision?
Receipt of Delayed Breast Reconstruction After Mastectomy: Do Women Revisit the Decision?
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DOI：
10.1245/s10434-010-1509-y
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发表时间：
2011-06-01
影响因子：
3.7
通讯作者：
Katz, Steven
中科院分区：
文献类型：
--
作者：
Alderman, Amy K.;Hawley, Sarah T.;Katz, Steven
乳房切除术后乳房重建是乳腺癌护理的重要组成部分，但很少有人在乳房切除术时接受重建。对于初始癌症治疗后是否接受重建以及为什么治疗可能会延迟几乎一无所知。一份为期 5 年的随访调查邮寄给了一组接受乳房切除术治疗的乳腺癌患者，这些患者在 2002 年诊断时进行了初步调查，并向洛杉矶和底特律 SEER 登记处报告（N = 645，响应率为 60%）。结果是接受重建（立即 [IR]、延迟 [DR] 或无）以及患者对其治疗决定的评估。约三分之一 (35.9%) 患有 IR，11.5% 患有 DR，52.6% 没有进行重建。三分之一的人推迟了重建，因为他们更关注其他癌症干预措施，近一半的人担心手术并发症和对癌症监测的干扰。三分之二没有进行重建的人表示手术对他们来说并不重要。所有患者中很大一部分对其重建决策感到满意（89.4% IR，78.4% DR，80.4% 未重建，P = NS）。然而，只有 59.3% 未进行重建的患者认为自己充分了解了重建选择（相对于 82.7% IR 和 78.4% DR，P < .01）。在初始癌症治疗后，乳房重建的采用率较低。与延迟重建相关的因素主要与手术的不确定性、对癌症监测的担忧以及低优先级有关。那些没有重建的人表现出巨大的信息需求，应该通过未来的研究工作来解决。
Postmastectomy breast reconstruction is an important component of breast cancer care, but few receive it at the time of the mastectomy. Virtually nothing is known about receipt of reconstruction after initial cancer therapy and why treatment might be delayed.A 5-year follow-up survey was mailed to a population-based cohort of mastectomy-treated breast cancer patients who were initially surveyed at time of diagnosis in 2002 and reported to the Los Angeles and Detroit SEER registries (N = 645, response rate 60%). Outcomes were receipt of reconstruction (immediate [IR], delayed [DR], or none) and patient appraisal of their treatment decisions.About one-third (35.9%) had IR, 11.5% had DR, and 52.6% had no reconstruction. One-third delayed reconstruction because they focused more on other cancer interventions, and nearly half were concerned about surgical complications and interference with cancer surveillance. Two-thirds of those with no reconstruction said that the procedure was not important to them. A large proportion of all patients were satisfied with their reconstruction decision-making (89.4% IR, 78.4% DR, 80.4% no reconstruction, P = NS). However, only 59.3% of those with no reconstruction felt that they were adequately informed about their reconstructive options (vs 82.7% IR and 78.4% DR, P < .01).There was modest uptake of breast reconstruction after initial cancer treatment. Factors associated with delayed reconstruction were primarily related to uncertainty about the procedure, concern about cancer surveillance, and low priority. Those without reconstruction demonstrated significant informational needs, which should be addressed with future research efforts.