Abstract PD08-03: Barriers to Breast Reconstructive Surgery in an Underprivileged Community: Does Income Really Matter?
Bibliographic record
Abstract
Abstract BACKGROUND: Although breast reconstruction is associated with multiple benefits, several barriers have been described including age, stage of disease or economic status. In an US study conducted in low-income patients, 37% have completed breast reconstructive surgery (BRS) (Maly, Cancer 2009). In universal healthcare systems however, little is known about the effect of these factors: in Canada (NS), the rate of BRS remains lower than in the USA (3.8%) without any influence of household income (Barnsley, Can J Surg 2008). We decided to evaluate barriers to BRS in an area (Seine-Saint-Denis, SSD) with an estimated population of 1.4 billion, which is among the poorest in France. Median household income is 68% lower than in Paris (+68%), a gap growing with time. In SSD, cancer is the leading cause of premature mortality. Yet, the area has no more than one academic cancer center. PATIENTS AND METHODS: Oncologie 93 is a non-profit organization whose aim is to provide supportive care, health education and counseling to cancer patients treated in various cancer centers in SSD. A phone survey was conducted using semi-structured interviews. All pts completed their chemotherapy 1 year ago. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring “precarity”, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score ≥30 and considered as severe when ≥40. RESULTS: Among 99 pts screened over a 10 months period, 42 underwent a mastectomy. Mean age was 54 but only 27% stayed professionally active, 30% were retired. A majority (60%) had a partner. The EPICES score was ≥30 in 45% of pts, and ≥40 in 35%, ie 2.5 fold higher than average. One year after therapy, only 5 pts (12%) had BRS but 17 (46%) of the remaining 37 pts were considering BRS. Only 3 of them (8%) already got an appointment with a plastic surgeon. Other patients (n = 19) were still undecided (51%). Main reasons invoked were: fear of a new surgical procedure (n = 10, 27%) or feeling unprepared to BRS (n = 9, 24%). Five patients (13%) considered BRS as “useless”: 4 of them were ≥65 and age was the main factor in their choice. Vulnerability was not correlated with the decisions about BRS, neither was marital status. Of note, for all patients but one financial difficulties were not regarded as a critical issue and all pts were aware that BRS can be reimbursed by the public health insurance; none of them, however, knew that extra fees were the rule when BRS is performed outside of public hospitals. CONCLUSIONS: In an universal healthcare system, only a minority of low-income or vulnerable patients choose BRS. Although BRS funding is usually not regarded as a problem, numerous barriers to BRS still exist, mainly related to irrational grounds or wrong beliefs. Whether these barriers can be overcome by improved patient-doctor communication or better information remains an issue. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD08-03.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".