4 research outputs found
Recommended from our members
Axillary management and long-term oncologic outcomes in breast cancer patients with clinical N1 disease treated with neoadjuvant chemotherapy
Recommended from our members
Persistent and interdependent: Racial disparities and their mechanisms in postmastectomy breast reconstruction
Racial disparities in accessing postmastectomy breast reconstruction persist despite expansion of insurance coverage. An updated examination with a broad assessment of mediating factors in a "majority minority" community is needed.
Data were collected on all patients undergoing mastectomy for breast cancer from 2011 to 2019 in a private academic center and adjacent safety-net hospital. Multivariable logistic regression was used to assess the effect of race on postmastectomy breast reconstruction, controlling for predetermined potentially mediating and confounding variables.
Of 1,554 patients, 63.8% (n = 203) of non-Hispanic White, 33.4% (n = 102) of Black, and 47.9% (n = 438) of Hispanic patients underwent postmastectomy breast reconstruction. Multivariable logistic regression showed that Black patients (odds ratio [OR] 3.6, 95% confidence internal [CI]: 2.2-5.9; P < .0001) undergo significantly less postmastectomy breast reconstruction than White patients. Age, insurance status, stage, and hospital type mediated this relationship.
Black patients have substantially reduced rates of postmastectomy breast reconstruction compared with White patients, which is mediated by socioeconomic factors
Recommended from our members
Risk assessment, prevention and early detection of breast cancer related lymphedema: Objective measurements and patient reported outcomes
128 Background: Breast cancer-related lymphedema (BCRL) affects the quality of life, but there is no consensus regarding early detection and monitoring. Patient-reported outcomes (PROs) are important in assessing cancer survivor outcomes. LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) and S-LYMPHA (Simplified LYMPHA) have reduced BCRL rates. This study aims to identify the most reliable PRO in a South Florida multi-ethnic population and to study correlations between PROs and objective measurements in the first 6 months after axillary surgery. Methods: Patients aged 18 and above undergoing axillary lymph node dissection (ALND) or axillary radiation were included. L-Dex (Spectroscopy) and three validated questionnaires (LyQLI, Lymphedema Quality of Life Inventory; LyQOL, Lymphedema Quality of Life and FACT-B4+ Functional Assessment of Cancer Therapy-Lymphedema) were recorded at baseline and 6 months post-surgery to assess the association between patient-reported symptoms and BCRL. Lymphedema was defined as L-Dex score outside the normal range, or a 10 unit increase above baseline. Additional variables such as demographics, tumor characteristics, and treatment modalities were considered. Results: Out of 40 recruited patients, 39 were analysed (excluding one deceased patient). One patient was male. Amongst the females,18 were pre-menopausal and 20 were post-menopausal. Hispanic ethnicity was reported by 23 (58.9%) patients compared to 16 (41%) non-Hispanic. White race, African American and other races were reported in 31, 4, and 4 patients respectively. 1, 22, and 16 patients had Cancer stages 1, 2, and 3 respectively. Neo-adjuvant therapy (endocrine or chemotherapy) was administered to 31 patients; 13 and 26 patients had lumpectomy and mastectomy respectively. 18 patients had breast reconstruction. Patients were divided into three groups for analysis: 1) ALND with no axillary radiation (n=33,85%); 2) Sentinel Lymph Node Biopsy (SLNB) with axillary radiation (n=3,8%); 3) ALND with axillary radiation (n=3,8%). In the first group, LYMPHA or S-LYMPHA were associated with lower rates of lymphedema (19% vs, 50%) (p=0.116). No patients in the second or third groups had lymphedema. There were 4 out of 20 (20%) patients with lymphedema with scores above the median for FACT B4+ (p= 0.41) and a lower score (higher quality of life) correlated with lower L-Dex value (p=0.76). The higher score in the physical domain of LyQLI showed higher L-Dex vaue (p=0.826). There was a significant inter-domain correlation in LyQLI and LyQOL (p<0.05 to <0.001). Conclusions: These preliminary results validate the use of PROs alongside objective measurements to assess BCRL. In addition, LYMPHA and S-LYMPHA significantly reduce lymphedema rates. Larger numbers will be necessary to reach statistical significance and to identify the best PRO