Cheung WL, Cannella C, Chen YL, Rama S, Yono S, Romano I, Bensenhaver J, Yoho D, and Atisha D. Patient and disease pre-operative factors influencing surgical procedure choice for breast cancer treatment. Ann Surg Oncol 2022; 29(SUPPL 1):226-226.
Ann Surg Oncol
Background/Objective: To address disparities of care in breast cancer treatment, it is important to understand pre‐operative factors that could affect the surgical decision‐making process.
Methods: This prospective cohort study evaluates patient‐reported outcomes in women undergoing breast cancer treatment at a metropolitan health care system. Each new breast cancer case undergoes tumor board discussion, and patients have same‐day consultations with various specialties. Based on their procedure choice, women choose to complete pre‐ and post‐operative Breast‐Q© Breast‐ conserving Surgery (BCS), Mastectomy (M), or Reconstruction ® modules and demographic surveys. Individual effects of pre‐operative factors on procedure choice were assessed using ANOVA for continuous variables and chi‐squared for categorical. Significant factors (p≤0.05) were added to a multinomial logistic regression model.
Results: A total of 375 women completed pre‐operative surveys (BCS=244, M=39, BR=92). Compared to BR, those chose BCS were older (RRR=1.094, p<0.001) with larger BMIs (RRR=1.094, p=0.001), without a history of breast cancer (RRR=0.130 (yes vs. no), p=0.016), and Stage I disease (RRR=4.920, p<0.001). Women making more than $200K (RRR=4.56x105 (vs. 35K), p<0.0001) were also more likely to undergo BR. Compared to BCS, women undergoing neoadjuvant chemotherapy (RRR=3.591, p=0.047) and Stage II disease (RRR=4.238, p=0.040) were more likely to undergo mastectomy alone, whereas race, education, employment, and most incomes did not correlate with procedure choice.
Conclusions: Our data suggest that racial and socioeconomic disparities in procedure type can be addressed by presenting equally effective surgical strategies to all patients in a multidisciplinary model that allows patients to interact with plastic surgeons, radiation oncologists, and surgical and medical oncologists.