Overall treatment concordance with goals high, but lower for women preferring mastectomy
MONDAY, Jan. 16 (HealthDay News) -- Many early-stage breast cancer survivors lack knowledge about their disease and report not being involved in treatment decisions, although most receive treatment consistent with their goals, according to a study published in the January issue of the Journal of the American College of Surgeons.
Clara N. Lee, M.D., M.P.P., from the University of North Carolina at Chapel Hill, and colleagues conducted a survey of stage I/II breast cancer survivors treated at four U.S. sites. Knowledge, goals, and involvement in decisions were assessed for 444 patients using the Decision Quality Instrument. For each patient, the model-predicted probability of mastectomy was compared with the treatment received. Concordance was defined as having mastectomy and a predicted probability of >0.5 or partial mastectomy and a predicted probability of <0.5.
The researchers found that the mean overall knowledge was 52.7 percent, with 45.9 percent of women knowing that local recurrence risk is higher after breast conservation and 55.7 percent of women knowing that survival is equivalent for the two surgical options. The majority of women (89.0 percent) received treatment consistent with their goals. Participants preferring mastectomy had significantly lower concordance (80.5 percent) than those preferring partial mastectomy (92.6 percent). Partial mastectomy and its advantages were more frequently discussed than mastectomy, and less than half of the participants (48.6 percent) reported being asked their surgical preference.
"Making improvements in the quality of breast cancer surgical decisions will require interventions to enhance patient knowledge and promote incorporation of preferences into treatment decisions," the authors write.
Full Text (subscription or payment may be required)
Editorial (subscription or payment may be required)