The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

ISSN 2347-954X (Print) Screening of Social Anxiety Disorder in the Overweight and Obese Subjects Attending Obesity Clinic

Abstract: Obesity is a complex, chronic disorder with potentially serious medical, psychiatric and psychological morbidity. Society has created a widely accepted physical stereotype regarding thinness and beauty. The stigma of obesity, and particularly the prejudice and overt discrimination create enormous distress and hampering in social functioning. Obese individuals who seek treatment may suffer greater levels of social anxiety and are more likely to experience body image concerns, e.g. thinking of their body as "grotesque". So, my purpose is to screen for social phobia in obese patients. Research was carried out in the obesity clinic, The Ramakrishna Ashram Hospital, Rajkot. Subjects' general data were filled in Socio-demographic Performa sheet and The Social anxiety was screened by Mini-SPIN scale. Out of 100 patients, female patients (29%) were having more social anxiety than male patients. Regarding the correlation with severity of obesity, mild and severe obese patients were having more social anxiety than pre-obese and moderately obese patients (44 % and 50% respectively). In our study we found that obese patients are likely to have more social anxiety and it need to be addressed in comprehensive treatment plan of obesity