Project Abstract
This is a collaborative, interdisciplinary project between the Division of Plastic and Reconstructive Surgery and the Department of Medical Social Sciences. The primary objective of this study is to investigate the role of race, insurance status, and neighborhood deprivation in breast reconstruction surgery complication outcomes. Prior studies have reported that Black and Hispanic women have significantly more risk factors for complications after breast reconstruction than White women, which contributes to poorer patient reported outcomes 1-9. One study conducted at a single, high-volume university-affiliated hospital found that among women preparing to undergo breast reconstruction surgery, Hispanic and African American patients had significantly higher BMIs (p < 0.001), higher rates of ASA class III or IV (p = 0.025), obesity, diabetes, hypertension (p < 0.001), and smoking (p = 0.003), and had more prior abdominal surgeries (p = 0.007) compared to white women, placing them at higher risk for the development of a post-surgical complication 7. As a result, White women who undergo breast reconstruction surgery consistently report higher satisfaction with their breast reconstruction outcomes compared to their Non-White peers 10-14 (Figure 1). Few studies have examined the role of social determinants of health (i.e. insurance status, and neighborhood deprivation) in the observed racial disparities in breast reconstruction complication outcomes. Previous studies have reported an association between black and hispanic race, neighborhood deprivation, and poorer survival outcomes in breast cancer patients. For Black patients with breast cancer in particular, neighborhood has been associated with aggressive tumor subtypes and increased mortality.15,16 One large-scale, post hoc analysis of a randomized clinical trial including 9719 women with breast cancer patients found that in multivariate models, Black race compared with White race was associated with statistically significant shorter relapse-free interval (hazard ratio [HR], 1.39; 95% CI, 1.05-1.84; P = .02) and overall survival (HR, 1.49; 95% CI, 1.10-2.99; P = .009). Further, participants living in neighborhoods in the highest neighborhood deprivation index (NDI) quartile experienced shorter overall survival compared with those in the lowest quartile (HR, 1.34; 95% CI, 1.01-1.77; P = .04), regardless of self-identified race( Sadigh, Figure 2). Given the clear association between race, social determinants of health, and breast cancer survival outcomes, there is a critical need to explore the intersection of race and social determinants of health in breast reconstruction complication outcomes. It is our hope that our research proposal will provide critical information about the potentially unique social challenges of Black and Hispanic patients as they navigate the breast reconstruction pathway, which may help to inform the development of targeted interventions aimed at improving the surgical outcomes of women of color affected by breast cancer.
Investigators
Robert Galiano, MD, Principal Investigator
Dr. Galiano is an Associate Professor of Plastic Surgery and the Co-Director of the Laboratory for Tissue Repair and Regenerative Surgery. Dr. Galiano runs a very busy clinical practice focused on a mixture of reconstructive surgery, breast surgery, and aesthetic surgery. He is recognized as an expert in breast reduction surgery in the Chicago area and is one of the busiest (if not the busiest) surgeons in Chicago for this operation. Dr. Galiano’s reputation for breast reduction surgery has expanded nationally and he has spoken at national meeting panels related to his published research on the topic. Recently, Dr. Galiano has expanded his interest in breast surgery to the care of patients needing breast reconstruction. By conducting clinical research studies, he hopes to identify and address health care disparities within the field of Plastic Surgery, specifically among Hispanic and Black patients. Dr. Galiano is recognized as a leading expert in the conduct of clinical trials to investigate novel scar therapeutics, and he continues to advise colleagues in industry and academia about designing clinical outcome studies. One exciting area of research Dr. Galiano has initiated is investigating the role that ethnicity/race has on breast reconstruction outcomes and scarring and fibrosis in skin of color. The former will be the focus of his clinical lab over the next few years.
Betina Yanez, PhD, Co-Investigator
Dr. Yanez is an Associate Professor in the Department of Medical Social Sciences. She is also the Cancer Control and Survivorship Program Co-Lead at the Robert H. Lurie Comprehensive Cancer Center. Her work bridges behavioral medicine and health equity research to investigate improvements in the patient-reported outcomes (PROs) and clinical outcomes of individuals diagnosed with cancer to translate evidence-based research into cancer care. To address the concerns faced by cancer patients, she has established an impactful and innovative research program that focuses on patient-centered care by engaging key stakeholders to address major public health problems facing cancer patients, optimize cancer-related outcomes, and enhance cancer care delivery. Dr. Yanez has published in high-impact journals such as Annals of Oncology, JAMA Oncology, Journal of Clinical Oncology, and Lancet Oncology. Her research is funded by the National Institutes of Health and the American Cancer Society.
David Cella, PhD, Co-Investigator
Dr. Cella is a professor and former chair of the Department of Medical Social Sciences. He plays a leadership role in the development and orchestration of transdisciplinary scientific collaborations. Dr. Cella has functioned as the PI on multiple trans-NIH initiatives and as an active collaborator on projects led by others. As a measurement scientist with expertise in applied health status measurement, Dr. Cella has led the development of numerous item banks and instruments, intended for both normal and clinical populations. Dr. Cella was the principal investigator of the trans-NIH NeuroQoL and the PROMIS Statistical Center. In the first cycle of PROMIS (2004-2009), Dr. Cella was PI of the Statistical Coordinating Center (SCC). Currently Dr. Cella serves as the MPI of the Environmental Children’s Health Outcomes (ECHO) Consortium PRO Core grant. A major focus of many of these initiatives has been ensuring measurement sensitive to diverse populations including issues of health literacy and health disparities and developmentally sensitive measurement across the lifespan.
Tokoya Williams, MD, Research Fellow
Dr. Williams is a Research Fellow with the Department of Plastic Surgery. She earned her M.D. from the University of Illinois Chicago and went on to complete three years of post-graduate training in general surgery and burn surgery. Dr. Williams completed a research fellowship in plastic surgery at Stanford University, where she was a member of the basic science lab; her research at Stanford focused on wound healing and tissue engineering. Dr. Williams is currently a Clinical Research Fellow for the Division of Plastic and Reconstructive Surgery. Her research focuses on racial disparities in breast reconstruction surgery. Dr. Williams will serve as the project lead, and will be directly responsible for data collection, data archiving, and general day-to-day interactions with study participants, surgeons, and support staff. Dr. Williams will also oversee medical students who may become peripherally involved in data collection and data analysis. Dr. Williams’ appointment is through Northwestern University (NU).