title: Barriers, beliefs and practice patterns for breast cancer reconstruction: A provincial survey.
abstract: BACKGROUND
  The purpose of this study was to characterize beliefs and practice patterns for breast cancer reconstruction among physicians who treat patients with breast cancer, in order to delineate current clinical practice. This survey was administered prior to Cancer Care Ontario guideline publication.
  
  
  METHODS
  Survey questions addressed four domains: survival, delayed or obscured recurrence detection, delayed adjuvant therapy, and aesthetics. The survey was administered to 1160 Ontario plastic and general surgeons and radiation and medical oncologists. Data were compared to published guidelines.
  
  
  RESULTS
  The overall response rate was 48%, with 57% of respondents treating breast cancer. Of those treating breast cancer, 75% are affiliated with an academic center. Immediate breast reconstruction (IBR) is not available to 28%. Autologous reconstruction is thought to interfere with recurrence detection by 23% (oncologists 30%, surgeons 19%, p = 0.04). For patients not expected to require radiation therapy, IBR is not supported by 30%. Autologous IBR is believed to delay delivery of adjuvant chemotherapy by 45% (oncologists 55%, surgeons 41%, p = 0.02). Up to 42% of respondents believe delays in adjuvant therapy delivery following IBR are due to insufficient health care resources (ie. coordinating an oncologic and reconstructive surgeon). Radiation therapy following reconstruction is believed to have negative aesthetic outcomes, and increase the need for revision surgery.
  
  
  CONCLUSIONS
  Unfavourable beliefs about certain clinical actions do not align with recent provincial guideline recommendations. Insufficient healthcare resources are perceived to be a significant barrier to IBR and timely care.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coroneos
authors.affiliation: Department of Surgery, Cambridge Memorial Hospital, Cambridge, Ontario, Canada.
authors.forename: Karina
authors.initials: K
authors.lastname: Roth-Albin
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, United States.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Rai
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amrit S
authors.initials: AS
authors.lastname: Rai
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sophocles H
authors.initials: SH
authors.lastname: Voineskos
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.affiliation: Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ronen
authors.initials: R
authors.lastname: Avram
authors.affiliation: Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: hellersurgonc@aol.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Heller
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000523:psychology*; D008875:Middle Aged; D000072103:Oncologists / Q000523:psychology*; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Breast neoplasms/surgery; Female; Humans; Mastectomy; Surgical flaps; Survey