Research- Breast Reconstruction

Consolidating expertise in breast reconstruction research and practice

 With generous support from the Friends of the Mater Foundation (FOTM), Breast & Surgical Oncology at The Poche Centre (BSO) is involved in several clinical trials and research projects relating to quality of life and clinical outcomes for women who have undergone mastectomy and breast reconstruction following breast cancer.  The BSO team is research active and is developing a solid track record in publishing on breast reconstruction issues. We are developing local, national and international collaborations with other breast reconstruction researchers and actively promote our work. The unit has an immediate breast reconstruction rate of 41%, over three times the national average.

Breast reconstruction research

Dr Kathy Flitcroft PhD, who has academic appointments with the Northern Clinical School and the School of Public Health at the University of Sydney, has been coordinating several BSO breast reconstruction projects, funded by the FOTM Foundation, since 2014.

Breast reconstruction and radiotherapy for breast cancer

This study was a retrospective observational clinical trial of women with breast cancer who had mastectomy, immediate breast reconstruction and post-mastectomy radiotherapy (PMRT). This clinical trial, led by A/Prof Meagan Brennan and Prof Andrew Spillane, examined the impact of PMRT on a range of outcomes including quality of life, satisfaction with breast surgery results, psychological distress, post-decisional regret and body image. Data were also collected on clinical and oncological outcomes.  Abstract

Quality of Life following Immediate, Delayed or no breast reconstruction (QoLID)

This pilot study is the first Australian prospective cohort study to look at the impact of the choice of breast reconstruction (immediate, delayed or none) on quality of life measures and clinical outcomes for women undergoing mastectomy and PMRT for breast cancer. It was developed by Dr April Wong, the first surgical post-fellowship trainee supported by the FOTM, in collaboration with the team at BSO and other academic quality of life leaders. It is a longitudinal observational study that follows women for five years following their mastectomy. Waikato Hospital in New Zealand joined the pilot study as a second site in August 2014.  Analysis of the three month data was presented by Dr Wong at the ANZ Breast Cancer Trials Group meeting in Perth in 2015. Recruitment to this study is now completed at both sites, with 92 women participating. Analysis of the 12 month data will commence in April 2017.

Improving Breast Reconstruction Equity of Access through Stakeholder consultation and Translation into policy and practice (I-BREAST)

Dr Flitcroft is also leading this project, a four-year case study. Previous research has demonstrated the quality of life, body image and other benefits of breast reconstruction (BR) for women undergoing mastectomy for breast cancer. Yet rates of BR in Australia (around 12%) remain well below those of the UK (up to 21%) and access to the full range of reconstruction options is often limited. This mixed methods project will systematically explore factors behind the low and uneven rates of breast reconstruction across Australia. The latest publicly available data on breast reconstruction practices in Australia, from the BreastSurgANZ Quality Audit (BQA) database, is from 2007. Since then, however, there has been an increase in the number of breast surgeons performing oncoplastic procedures and reconstructions, as well as more data available to suggest IBR is safe when patients are having adjuvant chemotherapy and radiotherapy. More recent data is essential to accurately reflect the current status of breast reconstruction surgery options available across Australia, in order to identify gaps in evidence-based practice.

The initial mapping component of this project, which linked the latest data on breast reconstruction practice with a range of variables including patient age, socioeconomic status, distance to travel for treatment, surgeon caseload, hospital caseload and private insurance, has been funded through the FOTM was completed in 2015.

Throughout 2016, Dr Flitcroft is continuing her background research into women’s reasons for choosing BR, their expectations of BR, and the level of decisional regret women feel about their choice. She is also completing interviews with breast and plastic surgeons, breast care nurses and women with breast cancer to canvass their views on access to BR in Australia, and what can be done to improve outcomes for women. Medical and radiation oncologists will also be surveyed for their views on potential health system barriers to BR.

The final part of the project, making recommendations to medical and policy decision-makers, will combine the quantitative and qualitative data to advocate for changes that are feasible and acceptable to all stakeholders. This process will commence in 2017.

Other projects

In addition, the BSO was a collaborating centre for An International Field Study of the Reliability and Validity of an EORTC Breast Reconstruction Questionnaire to Assess Quality of Life in all types of Breast Reconstruction – Phase IV. This was a major international study, run by the European Organisation for Research and Treatment of Cancer (EORTC), to validate a quality of life instrument specifically related to breast reconstruction. The BSO was one of the lead contributors to this study.

 Breast reconstruction publications

Publications from these research studies will reinforce the BSO’s growing expertise in this area.  Since 2014 , we have published 13 articles specifically on breast reconstruction, with another three under review:

Published:

1)     Wong A, Snook K, Brennan M, Flitcroft K, Tucker M, Hiercz D, Spillane A. Increasing breast reconstruction rates by offering more women a choice. ANZ Journal of Surgery 2014; 84: 31-36. Abstract

2)     Brennan ME, Spillane A, Flitcroft K, Snook K, Wong A. Platinum multidisciplinary breast cancer care or platinum breast reconstruction? ANZ Journal of Surgery 2014; 84(9): 604-605. Abstract

3)     Flitcroft K, Spillane A, Brennan M, Snook K, Costa D, Wong A. The importance of choice: A prospective evaluation of factors affecting preference for immediate, delayed or no reconstruction in the context of mastectomy and post-mastectomy radiotherapy for breast cancer [abstract]. Eur J Surg Onc 2014; 41(6): S24. Abstract

4)     Brennan ME, Flitcroft K, Warrier S, Snook K, Spillane AJ. Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. The Breast 2016; 30: 59-65. Abstract

5)     Flitcroft K, Brennan M, Costa D, Spillane A. Documenting patterns of access to breast reconstruction in Australia: The National Picture. The Breast 2016; 30: 47-53. Abstract

6)    Flitcroft K, Brennan, ME, Spillane AJ. Difficulties of sourcing Australian health data: The case of breast reconstruction. ANZ Journal of Surgery 2016. 86(7-8): 537-9. Abstract

7)     Oh D, Flitcroft K, Brennan ME, Spillane AJ. Patterns and outcomes of breast reconstruction in older women – a systematic review of the literature.  Eur J Surg Oncol 2016; 42: 604-615. Abstract

8)     Brennan ME, Flitcroft K, Warrier S, Snook K, Spillane AJ. Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. The Breast 2016; 30: 59-65. Abstract

9)     Flitcroft K, Brennan M, Costa D, Spillane A. Documenting patterns of access to breast reconstruction in Australia: The National Picture. The Breast 2016; 30: 47-53. Abstract

10)  Flitcroft K, Brennan, ME, Spillane AJ. Difficulties of sourcing Australian health data: The case of breast reconstruction. ANZ Journal of Surgery 2016. 86(7-8): 537-9. Link to journal

12)  Flitcroft K, Brennan ME, Costa D, Wong A, Snook K, Spillane AJ. An evaluation of factors affecting preference for immediate, delayed or no breast reconstruction in women with high risk breast cancer. Psycho-oncology 16 Feb 2016. doi: 10.1002/pon.4087. Abstract

13)  Winters Z, Azfal M, Rumpold G, Holzner B, Oberguggenburger A, Da Costa Vieira R, Hartnup S, Flitcroft K, Bjelic-Radisic V, Panouilleres M, Rydevik-Mani M, King M, Rutherford C. International validation of the EORTC Patient-Reported Outcome Measure (PROM) in breast reconstruction (BRR): Evaluating health related quality of life (HRQL) and clinical effectiveness [abstract]. Eur J Surg Oncol 2016. Abstract
DoI: http://dx.doi.org/10.1016.ejso.2016.02.042

 

Under review:

1)     Flitcroft K, Brennan M, Costa D, Spillane A. Estimating post-mastectomy breast reconstruction rates in Australia from a large subset of women with breast cancer: Variation between and within states and territories. Asian Pacific Journal of Clinical Oncology

2)     Flitcroft K, Brennan M, Spillane A. Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice. Quality of Life Research

3)     Flitcroft K, Brennan M, Spillane A. Women’s expectations of breast reconstruction following mastectomy for breast cancer. A systematic review. Supportive Care in Cancer

 

Breast reconstruction collaborations

In addition to our international collaboration with the EORTC group, we also have strong research links with several groups at The University of Sydney including the School of Public Health, the Northern Clinical School and the Psycho-Oncology Cooperative Research Group that has a focus on quality of life outcomes for cancer patients. The BSO has facilitated links with the Australasian Society of Plastic Surgeons (ASPS), and has written a position statement for Breast Surgeons ANZ (BreastSurgANZ) on recommended investigations prior to breast surgery, which the ASPS supports.  Position statement breast surgery