Second Opinions From Medical Oncologists for Early-Stage Breast Cancer Prevalence, Correlates, and Consequences

• Type of Material: Article
• Authors: Allison W. Kurian, Stanford University; Christopher R Friese, University of Michigan; Irina Bondarenko, University of Michigan; Reshma Jagsi, University of Michigan; Yun Li, University of Michigan; Ann S. Hamilton, University of Southern California; Kevin C. Ward, Emory University; Steven J. Katz, University of Michigan
• Language: English
• Date: 2017-03-01
• Publisher: American Medical Association
• Publication Version: Final Published Version
• Copyright Statement: © Copyright 2017 American Medical Association. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1001/jamaoncol.2016.5652
• Title of Journal or Parent Work: JAMA Oncology
• ISSN: 2374-2437
• Volume: 3
• Issue: 3
• Start Page: 391
• End Page: 397
• Grant/Funding Information: The collection of cancer incidence data in Georgia was supported by contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the NCI, and the CDC or their Contractors and Subcontractors is not intended nor should be inferred.; Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health under award number P01CA163233 to the University of Michigan.; The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.; The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the NCI’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California (USC), and contract HHSN261201000034C awarded to the Public Health Institute
• Keywords: OVARIAN-CANCER; WOMEN; POPULATION; Life Sciences & Biomedicine; GENE-EXPRESSION; RISK-ASSESSMENT; TUMOR BOARD; Science & Technology; ADJUVANT THERAPY; SURGICAL-MANAGEMENT; Oncology; HEREDITARY BREAST; CHEMOTHERAPY
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

IMPORTANCE Advances in the evaluation and treatment of breast cancer have made the clinical decision-making context much more complex. A second opinion from a medical oncologistmay facilitate decision making for women with breast cancer, yet little is known about second opinion use. OBJECTIVE To investigate the patterns and correlates of second opinion use and the effect on chemotherapy decisions. DESIGN, SETTING, AND PARTICIPANTS A total of 1901women newly diagnosed with stages 0 to II breast cancer between July 2013 and September 2014 (response rate, 71.0%) were accrued through 2 population-based Surveillance, Epidemiology, and End Results registries (Georgia and Los Angeles County, California) and surveyed about their experiences with medical oncologists, decision making, and chemotherapy use. MAIN OUTCOMES AND MEASURES Factors associated with second opinion usewere evaluated using logistic regression. Also assessed was the association between second opinion and chemotherapy use, adjusting for chemotherapy indication and propensity for receiving a second opinion. Multiple imputation and weighting were used to account for missing data. RESULTS A total of 1901 patients with stage I to II breast cancer (mean [SD] age, 61.6 [11.0] years; 1071 [56.3%] non-Hispanic white) saw any medical oncologist. Analysis of multiply imputed, weighted data (mean n = 1866) showed that 168 (9.8%) (SE, 0.74%) received a second opinion and 54 (3.2%) (SE, 0.47%) received chemotherapy from the second oncologist. Satisfaction with chemotherapy decisions was high and did not differ between those who did (mean [SD] , 4.3 [0.08] on a 1-to 5-point scale) or did not (4.4 [0.03] ) obtain a second opinion (P = .29). Predictors of second opinion use included college education vs less education (odds ratio [OR], 1.85; 95%CI, 1.24-2.75), frequent use of internet-based support groups (OR, 2.15; 95%CI, 1.12-4.11), an intermediate result on the 21-gene recurrence score assay (OR, 1.85; 95%CI, 1.11-3.09), and a variant of uncertain significance on hereditary cancer genetic testing (OR, 3.24; 95%CI, 1.09-9.59). After controlling for patient and tumor characteristics, second opinion use was not associated with chemotherapy receipt (OR, 1.04; 95%CI, 0.71-1.52). CONCLUSIONS AND RELEVANCE Second opinion use was low ( < 10%) among patients with early-stage breast cancer, and high decision satisfaction regardless of second opinion use suggests little unmet demand. Along with educational level and use of internet support groups, uncertain results on genomic testing predicted second opinion use. Patient demand for second opinions may increase as more complex genomic tests are disseminated.