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Breast
Cancer
Articles
Correlates of referral practices
of general surgeons to plastic surgeons for mastectomy
reconstruction Amy K. Alderman, MD, MPH 1 2
*
Sarah T. Hawley, PhD 2 3
Jennifer Waljee, MD 4
Monica Morrow, MD 5
Steven J. Katz, MD, MPH 2 3
1 Section of Plastic Surgery,
Department of Surgery, the University of Michigan Medical Center, Ann
Arbor, Michigan
2 Veterans Affairs Center for Practice Management and
Outcomes Research, Ann Arbor Veterans Affairs Health Care System, Ann
Arbor, Michigan
3 Division of General Medicine, Department of Internal
Medicine, the University of Michigan Medical Center, Ann Arbor,
Michigan
4 Robert Wood Johnson Clinical Scholars Program and
Department of Surgery, the University of Michigan Medical Center, Ann
Arbor, Michigan
5 Department of Surgical Oncology, Fox Chase Cancer Center,
Philadelphia, Pennsylvania email:
Amy K. Alderman (aalder@umich.edu)
* Correspondence to Amy K. Alderman, Section of Plastic Surgery,
Department of Surgery, University of Michigan, 2130 Taubman Center,
1500 East Medical Center Drive, Ann Arbor, MI 48109-0340
The ideas and opinions expressed herein
are those of the author, and no endorsement by the State of
California, Department of Health Services is intended or should be
inferred.
Fax: (734) 763-5354
Funded by:
National Cancer Institute; Grant Number: R01 CA8837-A1
National Institutes of Health
Department of Health and Human Services; Grant Number: N01-PC-35139,
N01-PC-65064
California Department of Health Services as part of the statewide
cancer reporting program mandated by California Health and Safety Code
Section 103885
Keywords
breast reconstruction • practice patterns • surgical decision-making •
Surveillance • Epidemiology • End Results
Abstract
BACKGROUND
General surgeons' attitudes toward breast reconstruction may affect
referrals to plastic surgeons. The propensity to refer to plastic
surgeons prior to surgical treatment decisions for breast cancer
varies markedly across general surgeons and is associated with receipt
of reconstruction. In this study, the authors used data from a large
physician survey to examine factors associated with general surgeons'
propensity to refer breast cancer patients to plastic surgeons prior
to mastectomy. METHODS
The authors surveyed all attending general surgeons (N = 456 surgeons)
from a population-based sample of breast cancer patients who were
diagnosed in Detroit and Los Angeles during 2002 (N = 1844 patients),
with a surgeon response rate of 80%. The dependent variable was
surgeon report of the percentage of their mastectomy patients in the
past 2 years who they referred to plastic surgeons prior to initial
surgery (referral propensity). Referral propensity was collapsed into
3 categories (<25%, 25-75%, and >75%) and regressed on the following
covariates using logistic regression: Surveillance, Epidemiology, and
End Results registry; number of years in clinical practice; surgeons'
sex; annual breast surgery volume; and hospital setting.
RESULTS
Only 24% of surgeons referred >75% of their patients to plastic
surgeons prior to surgery (high referral propensity). High referral
propensity was associated independently with surgeons who were women
(odds ratio [OR], 2.3; P = .03), high clinical breast surgery volume
(OR, 4.1; P < .01), and working in cancer centers (OR, 2.4; P = .01).
High-referral surgeons and low-referral surgeons also had different
beliefs about women's preferences for reconstruction, with the
low-referral surgeons perceiving more access barriers (cost,
availability of plastic surgeons) and a lower patient priority for
reconstruction. CONCLUSIONS
A large proportion of surgeons do not refer breast cancer patients to
plastic surgery at the time of surgical decision-making. Surgeons who
have a high referral propensity are more likely to be women, to have a
high clinical breast volume, and to work in cancer centers. These data
support the importance of comanagement through multidisciplinary care
models. Women need more opportunities to discuss reconstructive
options to make informed surgical treatment decisions about their
breast cancer. Cancer 2007. © 2007 American Cancer Society.
Received: 30 October 2006; Revised: 12 January 2007; Accepted: 19
January 2007 Source:
Wiley
InterScience
| Dr. Curcio: One of
the primary differences between a breast specialist and a
general surgeon in the care of a breast cancer patient is in the
education component. Our primary goal as breast specialists are
to educate the patient about the disease she faces and help her
to make informed decisions. Being referred to a plastic surgeon
early in the decision process will help the patient to clarify
what mastectomy may mean to them and what type of reconstruction
they are best suited for. We are very fortunate to have in our
community outstanding plastic surgeons who offer a wide range of
reconstructive options. Often knowledge of these options can a
women solidify her decisions |
Visit
"Advanced
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