Introduction: Access to breast reconstruction (BR) following mastectomy for breast cancer is an important aspect of survivorship for many women. Although up to 50% of women would choose to have BR if offered it, previous estimates of BR rates within Australia range from 8 to 16%.
Aim: To clarify the BR rates between and within regions of Australia and to report breast care nurses’ (BCNs) views on local barriers to BR.
Methods: Data sets from the BreastSurgANZ Quality Audit (BQA) and geospatial software were used to model the national and intra-state distribution of BR procedures performed on patients of BreastSurgANZ members in Australia in 2013. Data were analysed using chi-squared tests of independence. A survey of BCNs provided a snapshot of BR practice in 42 locations across Australia, including their views on the most significant barriers to BR access in their local areas.
Results: Analysis revealed a national BR rate of 18.3%. Statistically significant differences in BR uptake (p<.0001) were found between jurisdictions [χ2(df=7)=284.29], with BR more likely in younger women [χ2(df=14)=395.62] and in private hospitals (χ2= 63.99) and less likely in remote areas [χ2(df=4)= 66.49] and non-capital city areas within states [χ2=144.60]. BR was not reported in over 40% of hospitals where mastectomy was conducted by members of BreastSurgANZ, including 30% of hospitals within capital city regions. Analysis of the BCN survey data identified the most significant barriers to BR were cost, distance to travel, inadequate numbers of specialist breast and plastic surgeons and lack of theatre time. 42.5% of BCN respondents reported no BR was available in their city/town.
Conclusion: Access to BR services varies widely across Australia and barriers are multifaceted. This presentation concludes with a policy discussion of what factors should be considered in determining a feasible and acceptable distribution of BR services.