Travel Distance is Still a Barrier to Breast Reconstruction After Mastectomy

Travel Distance is Still a Barrier to Breast Reconstruction After Mastectomy
Travel Distance is Still a Barrier to Breast Reconstruction After Mastectomy

Travel distances continue to be a significant barrier to women undergoing breast reconstruction after mastectomy for breast cancer, reported a study in Plastic and Reconstructive Surgery (doi:10.1097/PRS.0000000000001847).

"While greater patient awareness and insurance coverage have contributed to greater breast reconstruction rates in the United States, geographic barriers to access this service remain, particularly to academic centers," according to the new research by Evan Matros, MD, a surgeon member of the American Society of Plastic Surgeons, and colleagues at Memorial Sloan Kettering Cancer Center, New York, New York.

The researchers analyzed the relationship between travel distance and breast reconstruction in more than 1 million US women who underwent mastectomy between 1998 and 2011, based on data drawn from the National Cancer Database. During the period studied, the overall rate of immediate breast reconstruction approximately tripled from 10.6% in 1998 to 32.2% in 2011.

The trend was likely a reflection of the Women's Health and Cancer Rights Act (WHCRA) of 1998, which mandated insurance payer coverage of breast reconstruction after mastectomy. The increase was greatest for implant-based reconstructions, although autologous breast reconstructions also increased.

"Patients who underwent mastectomy with immediate reconstruction had to travel significantly greater distances than patients who did not undergo reconstruction," Matros and coauthors reported in their study, based on an analysis of distances from the patients' homes to the treatment centers.

Reconstruction was performed in approximately 14% of women who traveled zero to 20 miles for breast cancer treatment, compared with nearly 25% of those traveling 100 to 200 miles.

In addition, the travel distance for patients undergoing breast reconstruction increased during the study period: by 2% per year, compared with no significant change for women who did not undergo reconstruction.

Reconstruction rates also varied by type of hospital: approximately 10% for women treated at community hospitals; 20% at comprehensive community hospitals, which provide a broader range of services; and 26% at academic hospitals. Average travel distance was approximately 20 miles for the 2 groups of community hospitals versus 47 miles for academic hospitals.

Travel distance to high-volume hospitals performing autologous reconstruction more than doubled, from 22 to 53 miles. That reflected the high concentration of such specialized centers in metropolitan areas.

Geography is a key contributor to unequal health care access, which is an important source of variation in health care outcomes. "The greater distance traveled by women undergoing breast reconstruction, as compared to mastectomy without reconstruction, suggests the presence of a geographic disparity," wrote Matros and colleagues.

The researchers believe their findings suggest that measures providing insurance coverage, such as the WHRCA and the Affordable Care Act, will not be sufficient to eliminate barriers to accessing breast reconstruction after mastectomy. They concluded, "Greater numbers of plastic surgeons, especially in community [hospitals], would be one method of addressing this inequality."

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