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Distance to surgeon, insurance type predicted postmastectomy breast reconstruction

Distance to a plastic surgeon and type of insurance plan were predictors of whether women received postmastectomy breast reconstruction, according to study results recently published in Plastic and Reconstructive Surgery.

Researchers in Chapel Hill, North Carolina, studied a state-based data set that combined the North Carolina Central Cancer Registry and administrative claims from Medicare, Medicaid and private insurance plans for women diagnosed with breast cancer between 2003 and 2006.

There were 5,381 women included in the study who had a mastectomy within 6 months of diagnosis and had continuous insurance enrollment at least 2 years postoperatively.

There were 1,130 women who underwent reconstruction. Odds of delayed vs. immediate reconstruction were determined through multivariable logistic regression.

There was a significant association between distance to a breast reconstructive surgeon and undergoing reconstruction, independent of age, race, rurality and lower household income, with an approximately 22% lower odds of undergoing breast reconstruction (OR = 0.78; 95% CI, 0.63-0.96) for women living 10 to 20 miles from the nearest surgeon. There was a 27% lower odds for women who lived more than 20 miles from the nearest surgeon when compared with women who lived within 10 miles. (OR = 0.73; 95% CI, 0.57-0.93).

Compared with women who had private insurance, women with Medicaid (OR = 0.24; 95% CI, 0.19-0.32) or Medicare (OR = 0.58; 95% CI, 0.45-0.74) had lower odds of undergoing reconstruction.

Likelihood of reconstruction also was decreased with advanced cancer stage and receiving radiation therapy. Rural residence, chemotherapy and radiation therapy were associated with delayed reconstruction.

“This is the first population-based study to demonstrate distance to care and insurance plan as significant predictors of receipt of breast reconstruction,” the researchers wrote. “Additional research is needed to understand health care barriers and to determine whether distance to a plastic surgeon can be ameliorated by outreach programs.”  – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.