P2-16-11: Role of Proper Patient Counselling in Combination with Effect of Socioeconomic Deprivation on the Rate of Immediate Breast Reconstruction after Mastectomy.
Authors: Chakrabarti M , Stallard S , Fitzgerald C , Obondo C , Weiler-Mithoff E , Doughty J , Romics L 
Published: June 2012

Introduction: current guidelines in the United Kingdom suggest that the possibility of breast reconstruction should be discussed with all patients prior to mastectomy. However, the majority of patients are still treated with mastectomy alone and no reconstruction is carried out. It has also been suggested that women from more deprived areas are less likely to undergo immediate breast reconstruction (IBR). We investigated potential pitfalls in patient counselling and consequent decision making contributing to present IBR rate in combination with the effect of socioeconomic deprivation.

Methods: data from 89 consecutive mastectomy patients was prospectively collected in a single centre in Glasgow between August 2010 and March 2011. Each patient was scored for deprivation based on The Scottish Index of Multiple Deprivation. The patients were then divided into two groups: high and low deprivation levels. Consultations about IR and patients’ acceptance of counselling were analysed. For statistical calculations Fischer's exact test was applied. Results: IBR was offered to 41 (46%) patients, but it was not to 42 (47%) (6 were excluded due to incomplete data). 25 patients accepted IBR, and of those 24 (27%) underwent IBR. 16 of 41 patients refused to undergo IBR due to lack of interest (10), not feeling ready for it (2), preference of delayed procedure (2) and fear of delaying adjuvant therapy (2). Of 42 patients whom IBR was not offered, only 10 were documented in the notes, while there was no reference for discussing reconstruction in 32 (36%) cases. Reasons for not even discussing reconstruction were the following: age (15), co-morbidities (18), locally advanced cancer (2), co-morbidities with age (5), and locally advanced cancer with age (2). As regards to socioeconomic deprivation; 44 (49%) patients were from deprived areas and 39 (44%) from affluent areas. 41 patients were offered IBR and of these 23 (26%) were from affluent areas compared to 18 (20%). Of the 42 patients who were not offered IR, 26 (29%) were from deprived while 16 (18%) from affluent areas (p&lt;0.05). Of the 44 deprived patients, 18 were offered IBR but 26 were not. 15 of 25 patients, who accepted IBR, were from affluent areas. The 16 patients who refused IBR had equal distribution of deprivation.

Conclusions: while none of the reasons for not offering IBR represent absolute contraindication to IBR, decisions about refusal are based mostly on patients’ subjective intuitions. Further, a greater proportion of the patients who were not offered IBR were from more deprived areas, and it seems that patients from affluent areas are more likely to be offered IBR compared to ones from deprived areas. However, confounding factors such as co-morbidities may contribute to the above. We believe, therefore, that detailed counselling about reconstruction of each patient requiring mastectomy is necessary, which is likely to further increase IBR rate.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-11.