Patient Reported Satisfaction and Quality of Life in Women Undergoing Breast Reconstruction After Mastectomy: A Comparison of English and Spanish Speaking Women
Amanda M. Rizzo, BA, Evan S. Garfein, MD, Lawrence Draper, MD, J. Alejandro Conejero, MD, Teresa Benacquista, MD, Katie E. Weichman, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Purpose: While the rates of reconstruction tend to be lower in non-English speaking women, potential disparities in satisfaction with surgical outcome in those who do pursue reconstruction is not clearly defined. Here, we aim to compare patient-reported outcomes and quality of life measures in English and Spanish-speaking women undergoing breast reconstruction after mastectomy.
Methods: A prospective cohort study of all patients undergoing breast reconstruction at Montefiore Medical Center between June 2015 and September 2017 was conducted. Patients were divided into two cohorts: English-speaking (ES) and Spanish-speaking (SS). Patients were analyzed based on demographic characteristics, operative procedure, and complication rates. The outcome measures of interest were BREAST-Q (Reconstruction Module) scores, collected preoperatively and one year postoperatively. Evaluated domains included psychosocial well-being, abdominal physical well-being, chest physical well-being, sexual well-being, satisfaction with breasts, satisfaction with information, and satisfaction with overall outcome. Distribution of scores deviated from normality, so median scores were compared between groups using Mann-Whitney tests.
Results: Seventy-nine patients were included for analysis (SS n=24 (30.4%), ES n=55 (69.6%). Mean age, education level, employment status, and reconstruction type (autologous or implant-based) did not differ between groups; however, a higher proportion of SS women were in the lowest income bracket (SS 81% under $20,000/year, ES 37% under $20,000/year; p=0.01). SS women had lower median preoperative physical well-being scores with respect to chest (SS 68 [IQR 60-75.5], ES 77 [IQR 63-91]; p=0.049) and abdomen (SS 72 [IQR 46-83], ES 83 [IQR 72-100]; p=0.01); these differences were not evident postoperatively (median survey follow-up 11.7 [IQR 5.8-13)] months). SS women also had significantly higher satisfaction with overall outcome postoperatively (SS 80.5 [IQR 67-100], ES 66.5 [IQR 50.5-80.5]; p<0.01). Groups showed similar satisfaction with breasts (SS 57 [IQR 44-62], ES 58 [IQR 47-65]; p=0.68) and information postoperatively (SS 77 [IQR 65-100], ES 75 [IQR 58-100]; p=0.79).
Discussion: Despite language barriers, Spanish-speaking women undergoing breast reconstruction do not appear to have diminished quality of life measures. In fact, they display higher overall satisfaction with outcome when compared to English-speaking patients.
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