Epidemiologic study to assess patient involvement in choice of adjuvant chemotherapy for breast cancer (PROSA Study)

Abstract

Introduction: The objective of the current study was to assess patient involvement in adjuvant chemotherapy choice, reasons for treatment choice and satisfaction with the chosen treatment, given that improvement in breast cancer survival has been accompanied by a greater demand for disease information from patients.

Material and methods: An epidemiologic, prospective, multicentre study was conducted with patients aged over 18 diagnosed with breast cancer stages I, II and III. The study, which was conducted prior to these patients initiating adjuvant chemotherapy, was based on a baseline visit and a follow-up visit. Data on sociodemographic and clinical variables were collected and a survey was administered to assess both the reasons for choosing particular treatments and ultimate satisfaction with the chosen treatment. Statistical procedures included a descriptive analysis, bivariate tests and logistic regression.

Results: A total of 613 patients were recruited with a mean (SD) age of 53.3 (10.8) years. Most patients had stage II breast cancer (53.9%) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 (82.8%). Of these patients, 58.3% were treated with taxanes (48.2% docetaxel, doxorubicin and cyclophosphamide) and 41.7% without (43.5% 5-fluorouracil, epirubicin and cyclophosphamide). At the baseline visit and final visit, 73.8% and 72.6% of patients, respectively, were aware of their diagnosis and prognosis. A total of 77.1% patients (64.7% who had followed their physician's advice) were involved in treatment choice and this involvement was directly related to improved ECOG performance status and information. A total of 78.7% of patients were very satisfied or satisfied with their treatment and 5.4% of patients refused to continue treatment (with 39.3% giving toxicity as the reason).

Conclusions: Although a high proportion of patients were involved in choosing their treatment, this involvement was not related to greater treatment satisfaction. Further research in routine clinical settings is needed in order to assess other factors related to choice of adjuvant chemotherapy, treatment satisfaction and long-term effectiveness (3-5 years).