(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient

Publication
Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Although recent data have been published regarding trends surrounding mastectomy with reconstruction for breast cancer, little data exist about predictors of immediate vs delayed reconstruction and the prevalence of reconstruction where it is traditionally contraindicated, such as inflammatory breast cancer and stage IV disease.

Allison A. Aggon, DO, Elin R. Sigurdson, MD, PhD, Eric Chang, MD, Brian L. Egleston, PhD, Sameer Patel, MD, Marcia Boraas, MD, Neal S. Topham, Richard J. Bleicher, MD; Fox Chase Cancer Center

Background: Although recent data have been published regarding trends surrounding mastectomy with reconstruction for breast cancer, little data exist about predictors of immediate vs delayed reconstruction and the prevalence of reconstruction where it is traditionally contraindicated, such as inflammatory breast cancer and stage IV disease.

Methods: Surveillance, Epidemiology, and End Results (SEER)-Medicare data were reviewed for women ≥ 66 years old and diagnosed between 1992 and 2005 with stage 0 through IV breast cancer. Immediate reconstruction was defined by claims dated the same day as their mastectomy, while delayed reconstruction was defined as reconstruction performed up to 36 months after that date. Postmastectomy radiotherapy was reviewed by searching for radiotherapy claims up to 1 year after mastectomy.

Results: Of the 50,843 women who underwent mastectomy, 5.8% had reconstruction, increasing from 3.2% to 7.3% (P < .0001) during the study period, with a maximum patient age of 99 years. There were 4.3% of the 783 having inflammatory breast cancer and 2.9% of the 1,241 patients with metastatic disease who underwent reconstruction. Implants, autologous tissue flaps (ATFs), the combination, and unspecified reconstruction types occurred in 57.2%, 20.4%, 17.0%, and 5.2%, respectively, with radiotherapy performed in 14.9%, 37.3%, 14.6%, and 51.0% of those respective groups. Postmastectomy radiotherapy was also performed in 23% of immediate and 14.9% of delayed reconstruction cases. Among all patients having reconstruction, 79% underwent immediate reconstruction and 21% had delayed reconstruction, with a median delay of 8.5 months. From 1998 to 2005, immediate reconstruction increased from 2.6% to 5.8%, while delayed reconstruction plateaued at ~1.4% in this period. The likelihood of having any reconstruction declined with increasing comorbidities (trend P < .0001). Delayed-reconstruction patients had greater comorbidities than those who had immediate reconstruction (trend P = .04). ATF patients had greater comorbidities than implant patients (P = .0003). Variables associated with delayed reconstruction (vs immediate) were SEER region (P < .0001), higher stage (P < .0001), postoperative radiotherapy (P < .0001), diagnosis year (P < .037), and comorbidity index (P = .037). Age, marital status, race, and histology were not predictive.

Conclusion: A small minority of patients have reconstruction when it is traditionally considered contraindicated. Radiotherapy was used more frequently in patients having immediate than delayed reconstruction, with ATF reconstruction used to a greater degree than implants in both immediate and delayed reconstruction groups. Although immediate reconstruction is on the rise, its use in Medicare patients remains low. Further efforts to educate clinicians and patients about eligibility for immediate reconstruction, even in those over 65 years of age, may be worthwhile.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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