The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population-based sample of breast cancer patients

• Type of Material: Article
• Authors: Sarah T. Hawley, University of Michigan Medical School; Kent A. Griffith, University of Michigan School of Public Health; Ann S. Hamilton, University of South Carolina; Kevin Ward, Emory University; Monica Morrow, Memorial Sloan-Kettering Cancer Center; Nancy K. Janz, University of Michigan School of Public Health; Steven J. Katz, University of Michigan Medical School; Reshma Jagsi, University of Michigan Medical School
• Language: English
• Date: 2017-12-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.30924
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 123
• Issue: 23
• Start Page: 4547
• End Page: 4555
• Grant/Funding Information: The ideas and opinions expressed herein are those of the author(s) and endorsement by the States of California and Georgia, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.; 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 National Cancer Institute, and the CDC or their Contractors and Subcontractors is not intended nor should be inferred.; The collection of Los Angeles County 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 National Cancer Institute’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, and contract HHSN261201000034C awarded to the Public Health Institute.; This work was funded by grant P01 CA163233 to the University of Michigan from the National Cancer Institute.
• Keywords: breast cancer; Health Knowledge, Attitudes, Practice; Adult; Middle Aged; Humans; Aged; Women; Insurance, Health; population-based survey; Prophylactic Mastectomy; Neoplasm Staging; Female; Breast Neoplasms; decision styles; United States; SEER Program; contralateral prophylactic mastectomy; Decision Making; Young Adult; Surveys and Questionnaires; decision making; Prognosis; Follow-Up Studies
• Research Categories: Health Sciences, Oncology

Abstract

BACKGROUND: Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with the consideration of different treatment options and specifically with the consideration of contralateral prophylactic mastectomy (CPM). METHODS: Newly diagnosed patients with early-stage breast cancer who were treated in 2013-2014 were identified through the Surveillance, Epidemiology, and End Results registries of Los Angeles and Georgia and were surveyed approximately 7 months after surgery (n = 2578; response rate, 71%). The primary outcome was the consideration of CPM (strong vs less strong). The association between patients' values and decision styles and strong consideration was assessed with multivariate logistic regression. RESULTS: Approximately one-quarter of women (25%) reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including a rational-intuitive approach to decision making, varied. The factors most valued by women at the time of treatment decision making were as follows: avoiding worry about recurrence (82%) and reducing the need for more surgery (73%). In a multivariate analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and those who valued avoiding radiation significantly more often strongly considered CPM (P <.05), whereas those who reported being more logical and those who valued keeping their breast did so less often. CONCLUSIONS: Many patients considered CPM, and the consideration was associated with both decision styles and values. The variability in decision styles and values observed in this study suggests that formally evaluating these characteristics at or before the initial treatment encounter could provide an opportunity for improving patient clinician discussions. Cancer 2017;123:4547-4555. © 2017 American Cancer Society.