TY - JOUR
T1 - Variation in the utilization of reconstruction following mastectomy in elderly women
AU - In, Haejin
AU - Jiang, Wei
AU - Lipsitz, Stuart R.
AU - Neville, Bridget A.
AU - Weeks, Jane C.
AU - Greenberg, Caprice C.
N1 - Funding Information:
ACKNOWLEDGMENT This study used the linked Surveillance, Epidemiology, and End Results (SEER) - Medicare database. This resource has been made available to the research community through collaborative efforts of the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS). We acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services; and the SEER Program tumor registries in the creation of the SEER-Medicare database. Haejin In was supported by a National Cancer Institute training grant (R25 CA92203), titled ‘‘Program in Cancer Outcomes Research Training’’.
PY - 2013/6
Y1 - 2013/6
N2 - Background: Regardless of their age, women who choose to undergo postmastectomy reconstruction report improved quality of life as a result. However, actual use of reconstruction decreases with increasing age. Whereas this may reflect patient preference and clinical factors, it may also represent age-based disparity. Methods: Women aged 65 years or older who underwent mastectomy for DCIS/stage I/II breast cancer (2000-2005) were identified in the SEER-Medicare database. Overall and institutional rates of reconstruction were calculated. Characteristics of hospitals with higher and lower rates of reconstruction were compared. Pseudo-RA2 statistics utilizing a patient-level logistic regression model estimated the relative contribution of institution and patient characteristics. Results: A total of 19,234 patients at 716 institutions were examined. Overall, 6 % of elderly patients received reconstruction after mastectomy. Institutional rates ranged from zero to >40 %. Whereas 53 % of institutions performed no reconstruction on elderly patients, 5.6 % performed reconstructions on more than 20 %. Although patient characteristics (%ΔRA2 = 70 %), and especially age (%ΔRA2 = 34 %), were the primary determinants of reconstruction, institutional characteristics also explained some of the variation (%ΔRA2 = 16 %). This suggests that in addition to appropriate factors, including clinical characteristics and patient preferences, the use of reconstruction among older women also is influenced by the institution at which they receive care. Conclusions: Variation in the likelihood of reconstruction by institution and the association with structural characteristics suggests unequal access to this critical component of breast cancer care. Increased awareness of a potential age disparity is an important first step to improve access for elderly women who are candidates and desire reconstruction.
AB - Background: Regardless of their age, women who choose to undergo postmastectomy reconstruction report improved quality of life as a result. However, actual use of reconstruction decreases with increasing age. Whereas this may reflect patient preference and clinical factors, it may also represent age-based disparity. Methods: Women aged 65 years or older who underwent mastectomy for DCIS/stage I/II breast cancer (2000-2005) were identified in the SEER-Medicare database. Overall and institutional rates of reconstruction were calculated. Characteristics of hospitals with higher and lower rates of reconstruction were compared. Pseudo-RA2 statistics utilizing a patient-level logistic regression model estimated the relative contribution of institution and patient characteristics. Results: A total of 19,234 patients at 716 institutions were examined. Overall, 6 % of elderly patients received reconstruction after mastectomy. Institutional rates ranged from zero to >40 %. Whereas 53 % of institutions performed no reconstruction on elderly patients, 5.6 % performed reconstructions on more than 20 %. Although patient characteristics (%ΔRA2 = 70 %), and especially age (%ΔRA2 = 34 %), were the primary determinants of reconstruction, institutional characteristics also explained some of the variation (%ΔRA2 = 16 %). This suggests that in addition to appropriate factors, including clinical characteristics and patient preferences, the use of reconstruction among older women also is influenced by the institution at which they receive care. Conclusions: Variation in the likelihood of reconstruction by institution and the association with structural characteristics suggests unequal access to this critical component of breast cancer care. Increased awareness of a potential age disparity is an important first step to improve access for elderly women who are candidates and desire reconstruction.
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U2 - 10.1245/s10434-012-2821-5
DO - 10.1245/s10434-012-2821-5
M3 - Article
C2 - 23263733
AN - SCOPUS:84878242365
SN - 1068-9265
VL - 20
SP - 1872
EP - 1879
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 6
ER -