A Survey to Assess Knowledge, Attitudes & Practices in Surgeons With Regards to Breast Conservation Surgery & Mastectomy
Condition: Health Personnel Attitude; Health Knowledge, Attitudes, Practice
Study type: Observational

Summary: 
      With increasing evidence the management of breast cancer surgery has seen a paradigm shift
      towards breast conservation, heralding an era of oncoplastic breast surgery. Despite data
      supporting BCS(breast conservative surgeries) in suitable patients with early breast cancer,
      a significant percentage of women in India who would be candidates for BCS still decide to
      undergo mastectomy. The factors that influence these treatment decisions are complex and
      involve issues regarding access to health care, concerns for cancer recurrence, and the
      impact of surgery on body image and sexuality.

      Surgeon plays an important role in patient selection for breast conservation based on
      clinico-pathological characters, explaining to patient regarding mandatory locoregional
      radiotherapy and regular follow up, helping patient make an informed decision by providing
      safety and outcome profile as compared to mastectomy. Surgeon's recommendations are
      considered as important as patient's perception of body image issues, while making the
      decision. Surgeon's recommendations are usually based on their knowledge and belief regarding
      patient's disease characteristics and their perceptions regarding patient's socioeconomic
      capabilities and perceived compliance to prescribed treatment plan.

      Hence we are conducting this web based e-survey in surgeons from Private hospitals (breast
      specific practice) Medical colleges and Regional Cancer Centers (RCC) with an aim to evaluate
      the to understand knowledge, attitude and practices of primary surgeons regarding breast
      conservation surgery Vs mastectomy in treatment of breast cancer.

      We plan to administer the questionnaire to approximately 100 surgeons, equally distributed
      within aforementioned sectors.
    

Detailed description: 
      With increasing evidence the management of breast cancer surgery has seen a paradigm shift
      towards breast conservation, heralding an era of oncoplastic breast surgery. Despite data
      supporting BCS in suitable patients with early breast cancer, a significant percentage of
      women in India who would be candidates for BCS still decide to undergo mastectomy. The
      factors that influence these treatment decisions are complex and involve issues regarding
      access to health care, concerns for cancer recurrence, and the impact of surgery on body
      image and sexuality.

      Interestingly, Barron Lerner observed the convergence of the women's liberation movement and
      the rise of Breast Conservation Surgery as the standard of surgical care in the treatment of
      early stage disease, implying that the felt need of breast conservation was important in
      stimulating research into breast conservation. One celebrated example of such demand was,
      writer Rosamond Babette who refused radical mastectomy when diagnosed with breast cancer in
      1971 and sought Bernard Fisher's expertise, who, in that era was offering partial mastectomy
      for early breast cancer. There is now Level I evidence favoring breast conservation surgery
      for early breast cancer. Decision of breast conservation surgery or mastectomy for early
      breast cancer, is based on the clinico-pathological factors, individual factors and physician
      factors. Each has its influence on the decision; making the decision process complex one.

      Age of patient at presentation is important factor and it appears logical that younger
      patients would prefer breast conservation over mastectomy. Two reviews of the National Cancer
      Database have demonstrated that on the background of increased numbers of breast conservation
      younger patients are being treated with mastectomy at higher rates than their older
      counterparts after adjusting for patient, facility, and tumor characteristics. The subset of
      women aged ≤ 35 years were twice as likely to undergo mastectomy compared to women aged 61-64
      years. These studies also reported similar trends with socioeconomic status, geography, and
      cancer stage. It is unclear why younger women may be opting for more extensive surgery. This
      may be due to a concern for locoregional recurrence in younger patients, although more
      aggressive surgery does not appear to affect breast cancer-specific survival.

      Availability of radiation facilities and patients' compliance has been studied in detail with
      reference to breast conservation. It has been seen that breast conservation rates are higher
      in tertiary care centers with easy accessibility to radiation facilities and within those
      patients who stay close by to radiation facilities.

      country of training, gender, or number of procedures. These studies suggested female gender,
      higher case number, training, and individual surgeon practice were associated with increased
      BCT rates.

      TMH Mumbai reports that the proportion of cases undergoing BCS has shown a significant upward
      trend from 12.6% in 1997 to 70% at present. However at institutes across India BCS rates
      quoted are less than 30%. Surgeon plays an important role in patient selection for breast
      conservation based on clinicopathological characters, explaining to patient regarding
      mandatory locoregional radiotherapy and regular follow up, helping patient make an informed
      decision by providing safety and outcome profile as compared to mastectomy. Surgeon's
      recommendations are considered as important as patient's perception of body image issues,
      while making the decision. Surgeon's recommendations are usually based on their knowledge and
      belief regarding patient's disease characteristics and their perceptions regarding patient's
      socioeconomic capabilities and perceived compliance to prescribed treatment plan. We intend
      to study surgeon's and patient's perspective regarding the decision making, by administering
      a questionnaire to them.

      In an attempt to provide all valid information in easily understandable language and in
      disambiguous manner various decision making aides have been prepared and studies. In one such
      study, patients and surgeons were interviewed to identify key factors influencing breast
      cancer surgery decisions. They were then incorporated into a decision board that could be
      reviewed at the time of surgical consultation.Randomized trial comparing the decision board
      to usual care demonstrated that patients who had surgical consultations with the decision
      board had higher knowledge scores regarding treatment options; less decisional conflict and
      were more satisfied with the decision-making process. In addition, patients in the decision
      board group were more likely to undergo BCS (94 vs. 76%, P = 0.03). Recent meta-analysis of
      studies using decision aids in breast cancer patients, demonstrated that women were 25% more
      likely to choose BCS over mastectomy if a decision aid was utilized.

      Nine studies examined how physician related factors influenced patient's choice of mastectomy
      versus BCT. The variables reported included comparing individual surgeons' numbers of breast
      conservations, medical oncology consultation, and specific surgeon demographics such as
      degree,country of training, gender, or number of procedures. These studies suggested female
      gender, higher case number, training, and individual surgeon practice were associated with
      increased BCT rates.

      TMH Mumbai reports that the proportion of cases undergoing BCS has shown a significant upward
      trend from 12.6% in 1997 to 70% at present. However at institutes across India BCS rates
      quoted are less than 30%. Surgeon plays an important role in patient selection for breast
      conservation based on clinicopathological characters, explaining to patient regarding
      mandatory locoregional radiotherapy and regular follow up, helping patient make an informed
      decision by providing safety and outcome profile as compared to mastectomy. Surgeon's
      recommendations are considered as important as patient's perception of body image issues,
      while making the decision. Surgeon's recommendations are usually based on their knowledge and
      belief regarding patient's disease characteristics and their perceptions regarding patient's
      socioeconomic capabilities and perceived compliance to prescribed treatment plan.

      We intend to study surgeon's perspective regarding the decision making, by administering a
      questionnaire to them.Aim of this study is to understand knowledge, attitude and practices of
      primary surgeons regarding breast conservation surgery vs mastectomy in treatment of breast
      cancer.
    

Intervention name(s): a survey questionnaire to find knowledge, attitude and practices in treatment of breast cancer.
Intervention type(s): Other
Intervention description(s): an electronic webbased survey to assess knowledge, attitudes and practices amongst surgeons with regards to breast conservation surgery and mastectomy
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        We plan to administer a questionnaire to surgeons working in Private hospital (brest
        Specific practice) Medical Colleges and Regional cancer centers sectors to gain the
        relevant information.

        We plan to administer the questionnaire to approximately 100 surgeons.