RECEIPT OF RECONSTRUCTIVE SURGERY IN LOW-INCOME BREAST CANCER PATIENTS: IMPACT OF PATIENT-PHYSICIAN INTERACTIONS.

Abstract

Background Reconstructive surgery (RS) is associated with better body image in postmastectomy women with breast cancer (BC). Low-income women receive less RS. We examined whether patient-physician interactions and its components could positively influence receipt of RS in underserved women. Methods Participants were 931 low-income BC patients receiving BC treatment through the Medi-Cal Breast and Cervical Cancer Treatment Program interviewed 6 months postdiagnosis. Subset receiving mastectomy analyzed (n = 357). Independent variables: four components of patient-physician communication - discussion of RS by health care provider, overall physician information giving, final treatment decision maker being self, and patient self-efficacy. Dependent variable: RS received or planned. Results In multiple logistic regression models, only discussion of RS by health care providers had a significant relationship with RS receipt or planned, controlling for a wide range of sociodemographic characteristics and other components of patient-physician communication. Specifically, discussion of reconstruction by any health care provider (OR = 5.80, CI = 2.8-12) and younger age (OR = 0.93, CI = 0.90-0.96) positively predicted received or planned RS. Asian Pacific Islander ethnicity (OR = 0.20, CI = 0.07-0.58) and being married/partnered (OR = 0.51, CI = 0.29-0.88) negatively predicted received or planned RS. Conclusion Specific discussion of reconstructive surgery may provide an avenue to mitigate disparities in receipt of RS in underserved women. Standardized protocols for discussion of BC treatment options should be considered, especially in populations less likely to benefit from state-mandated informational brochures due to language or literacy barriers.