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Few surgeons routinely refer breast cancer patients for reconstruction, U-M study finds

In addition, nearly half of the surgeons felt patients were concerned about the cost of reconstruction, despite a 1998 federal law that mandated insurance coverage of breast reconstruction. "Cost should not be an issue," Alderman says.

Surgeons who referred fewer patients to plastic surgery were more likely to identify patient barriers such as inadequate knowledge, cost concerns and availability of plastic surgeons, compared to surgeons who referred the majority of their patients for reconstruction.

"Knowing about reconstructive options appears to influence women's choice for surgical therapy. We have made some significant advances in reconstructive surgery where immediate reconstruction produces better aesthetic results. It also decreases health care costs because the patient has fewer surgeries," Alderman says.

The surgeons most likely to refer their patients to a plastic surgeon tended to be female, with a large volume of breast cancer patients. They were also more likely to work in a cancer center rather than a community hospital or teaching hospital.

The researchers suggest surgeons who do not refer as many patients for reconstruction may be more likely to treat patients with limited resources or to practice in settings with limited access to plastic surgeons.

"We, as a profession, need to do a better job at offering multidisciplinary care or improved decision aids so that patients can be fully educated about all of their treatment options. Co-management really improves the quality of patient care in several ways. In this case, it would better educate patients and allow them to more fully participate in their choices regarding their health care treatment," Alderman says.


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Contact: Nicole Fawcett
nfawcett@umich.edu
734-764-2220
University of Michigan Health System
26-Mar-2007


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