Premium
Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction
Author(s) -
Alderman Amy K.,
Hawley Sarah T.,
Waljee Jennifer,
Morrow Monica,
Katz Steven J.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22598
Subject(s) - medicine , referral , mastectomy , plastic surgery , breast cancer , breast reconstruction , specialty , general surgery , propensity score matching , odds ratio , population , surgery , family medicine , cancer , environmental health
BACKGROUND. General surgeons' attitudes toward breast reconstruction may affect referrals to plastic surgeons. The propensity to refer to plastic surgeons prior to surgical treatment decisions for breast cancer varies markedly across general surgeons and is associated with receipt of reconstruction. In this study, the authors used data from a large physician survey to examine factors associated with general surgeons' propensity to refer breast cancer patients to plastic surgeons prior to mastectomy. METHODS. The authors surveyed all attending general surgeons (N = 456 surgeons) from a population‐based sample of breast cancer patients who were diagnosed in Detroit and Los Angeles during 2002 (N = 1844 patients), with a surgeon response rate of 80%. The dependent variable was surgeon report of the percentage of their mastectomy patients in the past 2 years who they referred to plastic surgeons prior to initial surgery (referral propensity). Referral propensity was collapsed into 3 categories (<25%, 25–75%, and >75%) and regressed on the following covariates using logistic regression: Surveillance, Epidemiology, and End Results registry; number of years in clinical practice; surgeons' sex; annual breast surgery volume; and hospital setting. RESULTS. Only 24% of surgeons referred >75% of their patients to plastic surgeons prior to surgery (high referral propensity). High referral propensity was associated independently with surgeons who were women (odds ratio [OR], 2.3; P = .03), high clinical breast surgery volume (OR, 4.1; P < .01), and working in cancer centers (OR, 2.4; P = .01). High‐referral surgeons and low‐referral surgeons also had different beliefs about women's preferences for reconstruction, with the low‐referral surgeons perceiving more access barriers (cost, availability of plastic surgeons) and a lower patient priority for reconstruction. CONCLUSIONS. A large proportion of surgeons do not refer breast cancer patients to plastic surgery at the time of surgical decision‐making. Surgeons who have a high referral propensity are more likely to be women, to have a high clinical breast volume, and to work in cancer centers. These data support the importance of comanagement through multidisciplinary care models. Women need more opportunities to discuss reconstructive options to make informed surgical treatment decisions about their breast cancer. Cancer 2007. © 2007 American Cancer Society.