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. 2009 Nov 1;27(31):5160-7.
doi: 10.1200/JCO.2009.22.9773. Epub 2009 Sep 21.

Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust

Nina A Bickell  1 , Jessica Weidmann, Kezhen Fei, Jenny J Lin, Howard Leventhal
Affiliations

Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust

Nina A Bickell et al. J Clin Oncol. .

Abstract

Purpose: Little is known about why women with breast cancer who have surgery do not receive proven effective postsurgical adjuvant treatments.

Methods: We surveyed 258 women who recently underwent surgical treatment at six New York City hospitals for early-stage breast cancer about their care, knowledge, and beliefs about breast cancer and its treatment. As per national guidelines, all women should have received adjuvant treatment. Adjuvant treatment data were obtained from inpatient and outpatient charts. Factor analysis was used to create scales scored to 100 of treatment beliefs and knowledge, medical mistrust, and physician communication about treatment. Bivariate and multivariate analyses assessed differences between treated and untreated women.

Results: Compared with treated women, untreated women were less likely to know that adjuvant therapies increase survival (on a 100-point scale; 66 v 75; P < .0001), had greater mistrust (64 v 53; P = .001), and had less self-efficacy (92 v 97; P < .05); physician communication about treatment did not affect patient knowledge of treatment benefits (r = 0.8; P = .21). Multivariate analysis found that untreated women were more likely to be 70 years or older (adjusted relative risk [aRR], 1.11; 95% CI, 1.00 to 1.13), to have comorbidities (aRR, 1.10; 95% CI, 1.04 to 1.12), and to express mistrust in the medical delivery system (aRR, 1.003; 95% CI, 1.00 to 1.007), even though they were more likely to believe adjuvant treatments were beneficial (aRR, 0.99; 95% CI, 0.98 to 0.99; model c, 0.84; P < or = .0001).

Conclusion: Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of effective adjuvant therapies. Physicians may improve cancer care by ensuring that discussions about adjuvant therapy include a clear presentation of the benefits, not just the risks of treatment, and by addressing patient trust in and concerns about the medical system.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

References

    1. Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: Racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006;24:1357–1362. - PubMed
    1. Curtis E, Quale C, Haggstrom D, et al. Racial and ethnic differences in breast cancer survival: How much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics? Cancer. 2008;112:171–180. - PMC - PubMed
    1. Haggstrom DA, Quale C, Smith-Bindman R. Differences in the quality of breast cancer care among vulnerable populations. Cancer. 2005;104:2347–2358. - PubMed
    1. Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003;97:134–147. - PubMed
    1. Bickell NA, LePar F, Wang JJ, et al. Lost opportunities: Physicians' reasons and disparities in breast cancer treatment. J Clin Oncol. 2007;25:2516–2521. - PubMed

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