Influence of socioeconomic status on immediate breast reconstruction rate, patient information and involvement in surgical decision-making

Abstract

Background: Immediate breast reconstruction (IBR) rates in breast cancer differ between healthcare regions in Sweden. This is not explained by regional differences in patient age distribution or tumour characteristics, but by differences in patient-reported information and patient involvement in the decision-making process. As socioeconomic status may play a significant role in surgical decision-making, its potential associations with IBR rates were analysed. Methods: Women who had undergone therapeutic mastectomy for primary breast cancer in Sweden in 2013 were included in the analysis. Tumour and treatment data were retrieved from the Swedish National Breast Cancer Register, and socioeconomic background data from the Central Bureau of Statistics Sweden. Postal questionnaires regarding information about reconstruction and perceived involvement in the preoperative decision-making process had been sent out in a previous survey. Results: In addition to regional differences, lower tumour and nodal category, independent factors increasing the likelihood of having IBR for the 3131 women in the study were living without a registered partner, having current employment and high income per household. Patient-reported perceived preoperative information (odds ratio (OR) 12·73, 95 per cent c.i. 6·03 to 26·89) and the feeling of being involved in the decision-making process (OR 2·56, 1·14 to 5·76) remained strong independent predictors of IBR despite adjustment for socioeconomic factors. Importantly, responders to the survey represented a relatively young and wealthy population with a lower tumour burden. Conclusion: Several socioeconomic factors independently influence IBR rates; however, patient-reported information and involvement in the surgical decision-making process remain independent predictors for the likelihood of having IBR.