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. 2017 Dec 1;123(23):4547-4555.
doi: 10.1002/cncr.30924. Epub 2017 Aug 15.

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

Sarah T Hawley  1   2   3 , Kent A Griffith  4 , Ann S Hamilton  5 , Kevin C Ward  6 , Monica Morrow  7 , Nancy K Janz  3 , Steven J Katz  1   8 , Reshma Jagsi  9   10
Affiliations

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

Sarah T Hawley et al. Cancer. .

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.

Keywords: breast cancer; contralateral prophylactic mastectomy; decision making; decision styles; population-based survey.

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Conflict of interest statement

Conflicts of Interest: none

Figures

Figure 1
Figure 1
Patient values in breast cancer treatment decision making
Figure 2
Figure 2
Adjusted Associations (Odd Ratios) from Multivariate Model Explaining Patients' Strong Consideration of CPM adjusted for clustering at the surgeon level
See this image and copyright information in PMC

References

    1. Nash R, Goodman M, Lin CC, et al. State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004–2012. JAMA Surg. 2017 - PMC - PubMed
    1. Jagsi R, Hawley ST, Griffith KA, et al. Contralateral prophylactic mastectomy decisions in a population-based sample of patients with early-stage breast cancer. JAMA Surg. 2017;152(3):274–282. - PMC - PubMed
    1. Kurian AW, Griffith KA, Hamilton AS, et al. Genetic testing and counseling among patients with newly diagnosed breast cancer. JAMA. 2017;317(5):531–534. - PMC - PubMed
    1. Hawley ST, Jagsi R, Morrow M, et al. Social and Clinical Determinants of Contralateral Prophylactic Mastectomy. JAMA Surg. 2014;149(6):582–589. - PMC - PubMed
    1. Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–381. - PMC - PubMed

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