Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population
Abstract Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was perfor...
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| Veröffentlicht in: | The American journal of surgery 2015-06, Vol.209 (6), p.985-991 |
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| creator | Klemens, Anne E., M.D Olsen-Deeter, Lyndsay, M.D Hsu, Chiu-Hsieh, Ph.D Bouton, Marcia E., P.A.C Djenic, Brano, M.D Winton, Lisa M., M.D Komenaka, Ian K., M.D |
| description | Abstract Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size ( P = .035) and pathologic stage ( P = .003) remained associated with mastectomy, while use of preoperative chemotherapy ( P = .004) and type of surgeon ( P = .001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy. |
| doi_str_mv | 10.1016/j.amjsurg.2014.07.013 |
| format | Article |
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Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size ( P = .035) and pathologic stage ( P = .003) remained associated with mastectomy, while use of preoperative chemotherapy ( P = .004) and type of surgeon ( P = .001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2014.07.013</identifier><identifier>PMID: 25457245</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; African Americans ; Aged ; Arizona ; Body mass index ; Breast cancer ; Breast conservation ; Breast Neoplasms - economics ; Breast Neoplasms - ethnology ; Breast Neoplasms - surgery ; Confidence intervals ; Decision making ; Ethnicity ; European Continental Ancestry Group ; Female ; Hispanic Americans ; Histology ; Hospitals ; Humans ; Logistic Models ; Lumpectomy ; Mammography ; Mastectomy - economics ; Mastectomy - statistics & numerical data ; Mastectomy - utilization ; Mastectomy, Segmental - economics ; Mastectomy, Segmental - statistics & numerical data ; Mastectomy, Segmental - utilization ; Medically Uninsured ; Middle Aged ; Minority ; Minority Groups ; Multivariate Analysis ; Odds Ratio ; Population ; Preoperative chemotherapy ; Race ; Retrospective Studies ; Safety-net Providers ; Studies ; Surgery ; Surgical outcomes ; Uninsured people ; Womens health</subject><ispartof>The American journal of surgery, 2015-06, Vol.209 (6), p.985-991</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-54edf183d227be1c1a7e7d9ca295bc81efaac1cfe0c10b0c3ce6d51788a58b9c3</citedby><cites>FETCH-LOGICAL-c518t-54edf183d227be1c1a7e7d9ca295bc81efaac1cfe0c10b0c3ce6d51788a58b9c3</cites><orcidid>0000-0002-1479-5639</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1682798376?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994,64384,64386,64388,72340</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25457245$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Klemens, Anne E., M.D</creatorcontrib><creatorcontrib>Olsen-Deeter, Lyndsay, M.D</creatorcontrib><creatorcontrib>Hsu, Chiu-Hsieh, Ph.D</creatorcontrib><creatorcontrib>Bouton, Marcia E., P.A.C</creatorcontrib><creatorcontrib>Djenic, Brano, M.D</creatorcontrib><creatorcontrib>Winton, Lisa M., M.D</creatorcontrib><creatorcontrib>Komenaka, Ian K., M.D</creatorcontrib><title>Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size ( P = .035) and pathologic stage ( P = .003) remained associated with mastectomy, while use of preoperative chemotherapy ( P = .004) and type of surgeon ( P = .001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.</description><subject>Adult</subject><subject>African Americans</subject><subject>Aged</subject><subject>Arizona</subject><subject>Body mass index</subject><subject>Breast cancer</subject><subject>Breast conservation</subject><subject>Breast Neoplasms - economics</subject><subject>Breast Neoplasms - ethnology</subject><subject>Breast Neoplasms - surgery</subject><subject>Confidence intervals</subject><subject>Decision making</subject><subject>Ethnicity</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Hispanic Americans</subject><subject>Histology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Lumpectomy</subject><subject>Mammography</subject><subject>Mastectomy - economics</subject><subject>Mastectomy - statistics & numerical data</subject><subject>Mastectomy - utilization</subject><subject>Mastectomy, Segmental - economics</subject><subject>Mastectomy, Segmental - statistics & numerical data</subject><subject>Mastectomy, Segmental - utilization</subject><subject>Medically Uninsured</subject><subject>Middle Aged</subject><subject>Minority</subject><subject>Minority Groups</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Population</subject><subject>Preoperative chemotherapy</subject><subject>Race</subject><subject>Retrospective Studies</subject><subject>Safety-net Providers</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Uninsured people</subject><subject>Womens health</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFksGO1DAMhisEYmcXHgEUiQsHOsRt06QXEFqxgLQSB-AcpYnLpLRJSVLQvD2pZhakvXCKbH127P93UTwDugcK7etxr-YxruH7vqLQ7CnfU6gfFDsQvCtBiPphsaOUVmXXAr0oLmMccwjQ1I-Li4o1jFcN2xXTjdLJh0h-H6w-EDUMqBNJByRrROIHMq3zklN-PhLlDJlVTOfQupwhqzMYrMuToHlFohowHYnDRA4-LjapiSx-WSeVrHdPikeDmiI-Pb9Xxbeb91-vP5a3nz98un53W2oGIpWsQTOAqE1V8R5Bg-LITadV1bFeC8BBKQ16QKqB9lTXGlvDgAuhmOg7XV8VL099l-B_rhiTnG3UOE3KoV-jhFbUjLOG84y-uIeOfg0uT7dRFe9EzdtMsROlg48x4CCXYGcVjhKo3OyQozzbITc7JOUy25Hrnp-7r_2M5m_Vnf4ZeHsCMMvxy2KQUVt0Go0NWWZpvP3vF2_uddCTdVar6QceMf7bRsZKUvllu4ntJKChlNEO6j85WrUm</recordid><startdate>20150601</startdate><enddate>20150601</enddate><creator>Klemens, Anne E., M.D</creator><creator>Olsen-Deeter, Lyndsay, M.D</creator><creator>Hsu, Chiu-Hsieh, Ph.D</creator><creator>Bouton, Marcia E., P.A.C</creator><creator>Djenic, Brano, M.D</creator><creator>Winton, Lisa M., M.D</creator><creator>Komenaka, Ian K., M.D</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1479-5639</orcidid></search><sort><creationdate>20150601</creationdate><title>Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population</title><author>Klemens, Anne E., M.D ; Olsen-Deeter, Lyndsay, M.D ; Hsu, Chiu-Hsieh, Ph.D ; Bouton, Marcia E., P.A.C ; Djenic, Brano, M.D ; Winton, Lisa M., M.D ; Komenaka, Ian K., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-54edf183d227be1c1a7e7d9ca295bc81efaac1cfe0c10b0c3ce6d51788a58b9c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>African Americans</topic><topic>Aged</topic><topic>Arizona</topic><topic>Body mass index</topic><topic>Breast cancer</topic><topic>Breast conservation</topic><topic>Breast Neoplasms - economics</topic><topic>Breast Neoplasms - ethnology</topic><topic>Breast Neoplasms - surgery</topic><topic>Confidence intervals</topic><topic>Decision making</topic><topic>Ethnicity</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Hispanic Americans</topic><topic>Histology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Lumpectomy</topic><topic>Mammography</topic><topic>Mastectomy - economics</topic><topic>Mastectomy - statistics & numerical data</topic><topic>Mastectomy - utilization</topic><topic>Mastectomy, Segmental - economics</topic><topic>Mastectomy, Segmental - statistics & numerical data</topic><topic>Mastectomy, Segmental - utilization</topic><topic>Medically Uninsured</topic><topic>Middle Aged</topic><topic>Minority</topic><topic>Minority Groups</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Population</topic><topic>Preoperative chemotherapy</topic><topic>Race</topic><topic>Retrospective Studies</topic><topic>Safety-net Providers</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Uninsured people</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Klemens, Anne E., M.D</creatorcontrib><creatorcontrib>Olsen-Deeter, Lyndsay, M.D</creatorcontrib><creatorcontrib>Hsu, Chiu-Hsieh, Ph.D</creatorcontrib><creatorcontrib>Bouton, Marcia E., P.A.C</creatorcontrib><creatorcontrib>Djenic, Brano, M.D</creatorcontrib><creatorcontrib>Winton, Lisa M., M.D</creatorcontrib><creatorcontrib>Komenaka, Ian K., M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Klemens, Anne E., M.D</au><au>Olsen-Deeter, Lyndsay, M.D</au><au>Hsu, Chiu-Hsieh, Ph.D</au><au>Bouton, Marcia E., P.A.C</au><au>Djenic, Brano, M.D</au><au>Winton, Lisa M., M.D</au><au>Komenaka, Ian K., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2015-06-01</date><risdate>2015</risdate><volume>209</volume><issue>6</issue><spage>985</spage><epage>991</epage><pages>985-991</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size ( P = .035) and pathologic stage ( P = .003) remained associated with mastectomy, while use of preoperative chemotherapy ( P = .004) and type of surgeon ( P = .001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25457245</pmid><doi>10.1016/j.amjsurg.2014.07.013</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1479-5639</orcidid></addata></record> |
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| subjects | Adult African Americans Aged Arizona Body mass index Breast cancer Breast conservation Breast Neoplasms - economics Breast Neoplasms - ethnology Breast Neoplasms - surgery Confidence intervals Decision making Ethnicity European Continental Ancestry Group Female Hispanic Americans Histology Hospitals Humans Logistic Models Lumpectomy Mammography Mastectomy - economics Mastectomy - statistics & numerical data Mastectomy - utilization Mastectomy, Segmental - economics Mastectomy, Segmental - statistics & numerical data Mastectomy, Segmental - utilization Medically Uninsured Middle Aged Minority Minority Groups Multivariate Analysis Odds Ratio Population Preoperative chemotherapy Race Retrospective Studies Safety-net Providers Studies Surgery Surgical outcomes Uninsured people Womens health |
| title | Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population |
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