The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy

the iBRA-2 study

iBRA-2 Steering Group, Breast Reconstruction Research Collaborative

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.

METHODS: Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.

RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.

CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

Original languageEnglish
Pages (from-to)883-895
Number of pages13
JournalBritish Journal of Cancer
Volume120
DOIs
Publication statusPublished - 29 Mar 2019

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Mammaplasty
Mastectomy
Therapeutics
Breast Implants
Adjuvant Radiotherapy
Surgical Flaps
Free Tissue Flaps
Adjuvant Chemotherapy
Patient Selection
Quality of Life
Demography
Breast Neoplasms
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy : the iBRA-2 study. / iBRA-2 Steering Group; Breast Reconstruction Research Collaborative.

In: British Journal of Cancer, Vol. 120, 29.03.2019, p. 883-895.

Research output: Contribution to journalArticle

iBRA-2 Steering Group ; Breast Reconstruction Research Collaborative. / The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy : the iBRA-2 study. In: British Journal of Cancer. 2019 ; Vol. 120. pp. 883-895.
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title = "The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study",
abstract = "BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.METHODS: Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7{\%}) underwent IBR (implant-only [n = 675, 26.6{\%}]; pedicled flaps [n = 105,4.1{\%}] and free-flaps [n = 228, 8.9{\%}]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6{\%}) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.",
author = "O'Connell, {Rachel L} and Tim Rattay and Dave, {Rajiv V} and Adam Trickey and Joanna Skillman and Barnes, {Nicola L P} and Matthew Gardiner and Adrian Harnett and Shelley Potter and Chris Holcombe and Yazan Masannat and {iBRA-2 Steering Group} and {Breast Reconstruction Research Collaborative}",
note = "The datasets generated during and/or analysed during the current study are not publicly available due to ongoing analyses but are available from the corresponding author on reasonable request.",
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T1 - The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy

T2 - the iBRA-2 study

AU - O'Connell, Rachel L

AU - Rattay, Tim

AU - Dave, Rajiv V

AU - Trickey, Adam

AU - Skillman, Joanna

AU - Barnes, Nicola L P

AU - Gardiner, Matthew

AU - Harnett, Adrian

AU - Potter, Shelley

AU - Holcombe, Chris

AU - Masannat, Yazan

AU - iBRA-2 Steering Group

AU - Breast Reconstruction Research Collaborative

N1 - The datasets generated during and/or analysed during the current study are not publicly available due to ongoing analyses but are available from the corresponding author on reasonable request.

PY - 2019/3/29

Y1 - 2019/3/29

N2 - BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.METHODS: Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

AB - BACKGROUND: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy.METHODS: Consecutive women undergoing mastectomy ± IBR for breast cancer July-December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored.RESULTS: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays.CONCLUSIONS: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients.

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U2 - 10.1038/s41416-019-0438-1

DO - 10.1038/s41416-019-0438-1

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VL - 120

SP - 883

EP - 895

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

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