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Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients’ informed discussion of BR options and to improve access to BR for women living in underserved locations.

Methods

Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas.

Results

Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers.

Conclusions

Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK’s system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.

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References

  1. Howes BHL, Watson DI, Xu C, Fosh B, Canepa M, Dean NR (2016) Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study. J Plast Reconstr Aesth Surg 69:1184–1191

    Article  Google Scholar 

  2. National Clinical Audit Support Programme (NCASP) A national audit of provision and outcomes of mastectomy and breast reconstruction surgery for women in England. Fourth Annual Report 2011. The information Centre (NHS), London https://digitalnhsuk/catalogue/PUB02731 Accessed 10 April 2019

  3. Musgrave KJ, Bochner M, Kollias J (2010) Surgical decision-making in immediate breast reconstruction. World J Surg 34:3029–3035

    Article  Google Scholar 

  4. Cordeiro PG (2008) Breast reconstruction after surgery for breast cancer. New Eng J Med 359:1590–1601

    Article  CAS  Google Scholar 

  5. Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR (2005) Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 75:940–947

    Article  Google Scholar 

  6. Rowland JH, Holland JC, Chaglassian T, Kinne D (1993) Psychological response to breast reconstruction: expectations for and impact on postmastectomy functioning. Psychosomatics 34(3):241–250

    Article  CAS  Google Scholar 

  7. National Comprehensive Cancer Network. NCCN Guidelines Version 3.2013. Breast Cancer. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf Accessed 10 April 2019

  8. National Institute for Health and Care Excellence (NICE) Guidelines. Breast Cancer (Early & Locally Advanced) February 2009. http://www.nice.org.uk/guidance/CG80 Accessed 10 April 2019

  9. European Society of Breast Cancer Specialists (EUSOMA). Breast Unit Guidelines. Breast Surgeons. https://www.eusoma.org/en/recommendations/breast-centre-requirements/1-148-1- Accessed 20 May 2019

  10. Cancer Australia. Influencing best practice in breast cancer. Practice 11. 2016, Surry Hills, NSW: Cancer Australia. https://canceraustraliagovau/system/tdf/publications/influencing-best-practice-breast-cancer/pdf/statement_influencing-best-practice-in-breast-cancer.pdf?file=1&type=node&id=4566 Accessed 10 April 2019

  11. Flitcroft K, Brennan M, Costa D, Spillane A (2016) Documenting patterns of access to breast reconstruction in Australia: the National Picture. Breast 30:47–53

    Article  Google Scholar 

  12. Flitcroft KL, Brennan ME, Costa DSJ, Spillane AJ (2017) Regional variation in immediate breast reconstruction in Australia. Br J Surg Open 1:114–121

    CAS  Google Scholar 

  13. Feng Y, Flitcroft K, van Leeuwen MT, Elshaug AG, Spillane A, Pearson S-A (2019) Patterns of immediate breast reconstruction in New South Wales, Australia: a population-based study. ANZ J Surg. https://doi.org/10.1111/ans.15381

  14. Breast Cancer Network Australia (BCNA). The financial impact of breast cancer. BCNA; Melbourne: 2017. https://www.bcna.org.au/media/5609/the-financial-impact-of-breast-cancer.pdf Accessed 10 April 2019

  15. Flitcroft K, Brennan M, Spillane A (2019) Principles of patient-centred care and barriers to their implementation: a case study of breast reconstruction in Australia. Support Care Cancer:1–19. https://doi.org/10.1007/s00520-019-04978-9

  16. Australian Bureau of Statistics. 1270.0.55.005 – Australian Statistical Geography Standard (ASGS): Volume 5 – Remoteness Structure, July 2016. https://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure Accessed 3 January 2019

  17. Flitcroft KL, Brennan ME, Spillane AJ (2019) The impact on Australian women of lack of choice of breast reconstruction options: a qualitative study. Psycho-oncology 28(3):547–552. https://doi.org/10.1002/pon.4974

    Article  PubMed  Google Scholar 

  18. Porter ME, Lee TH (2013) The strategy that will fix health care. Harvard Business Review, October

    Google Scholar 

  19. Cancer Australia. National Framework for Gynaecological Cancer Control. 2016. https://canceraustralia.gov.au/system/tdf/publications/national-framework-gynaecological-cancer-control/pdf/2016_gcnf_gynae_framework.pdf?file=1&type=node&id=4382 Accessed 26 March 2019

  20. Galiano-Castillo N, Cantarero-Villanueva I, Fernández-Lao C, Ariza-García A, Díaz-Rodríguez L, Del-Moral-Ávila R et al (2016) Telehealth system: a randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer 122(20):3166–3174. https://doi.org/10.1002/cncr.30172

    Article  PubMed  Google Scholar 

  21. Ferrah N, Stephan K, Lovell J, Beiles, Ibrahim JE. Rural centres do not have a higher prevalence of post-operative complications than urban centres: A retrospective analysis of a mortality audit. ANZ J Surg 2019. Doi: https://doi.org/10.1111/ans.15083

  22. Worley P, Lowe M, Notaras L, Strasser S, Kidd M, Slee M et al (2019) The Northern Territory Medical Program – growing our own in the NT. Rural Remote Health 19:4671. https://doi.org/10.22605/RRH4671

    Article  PubMed  Google Scholar 

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Acknowledgments

A Consumer Advisory Panel (CAP) of six women with breast cancer, including an officially appointed representative from Breast Cancer Network Australia (BCNA), provided input into draft questionnaires and participant information to be sent to other women with breast cancer, breast care nurses and breast surgeons. We are grateful for their assistance, as well as to the participants in this project.

Project details

Improving Breast Reconstruction Equity of Access through Stakeholder consultation and Translation into policy and practice (I-BREAST) study. Funded through Friends of the Mater, North Sydney. 2014–2019. This project is registered with the Australian New Zealand Clinical Trials Registry. Registration No: 12616000188437 [www.anzctr.org.au/].

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Authors and Affiliations

  1. Breast & Surgical Oncology at The Poche Centre, 40 Rocklands Rd, Wollstonecraft, Sydney, NSW, 2065, Australia

    Kathy Flitcroft, Meagan Brennan, Shehnarz Salindera & Andrew Spillane

  2. Northern Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia

    Kathy Flitcroft, Meagan Brennan & Andrew Spillane

  3. Westmead Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia

    Meagan Brennan & Shehnarz Salindera

  4. The Mater Hospital, North Sydney, NSW, 2060, Australia

    Andrew Spillane

  5. Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia

    Andrew Spillane

Authors
  1. Kathy Flitcroft
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  2. Meagan Brennan
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  3. Shehnarz Salindera
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  4. Andrew Spillane
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Corresponding author

Correspondence to Kathy Flitcroft.

Ethics declarations

Ethics approval was obtained from the Human Research Ethics Committee (HREC) of St Vincent’s & Mater Health, Sydney, Australia, in April 2015 (14/181).

Conflict of interest

KF’s salary is funded by The Friends of the Mater Foundation, Sydney, Australia. The Friends of the Mater Foundation have had no influence on the conduct of this project or the preparation of this article. All authors declare they have no conflicts of interest. KF has full control of all primary data. This data has not been deposited into a public repository to protect the anonymity of interview respondents. The journal may review de-identified data if requested.

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Flitcroft, K., Brennan, M., Salindera, S. et al. Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia. Support Care Cancer 28, 2843–2856 (2020). https://doi.org/10.1007/s00520-019-05130-3

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  • DOI: https://doi.org/10.1007/s00520-019-05130-3

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