Abstract P6-07-01: Are patient perceptions and expectations about peri-operative imaging for metastatic breast cancer in keeping with current guidelines?
Authors: Simos D , Hutton B , Mazzarello S , Graham I , Caudrelier J-M , Gertler S , Wheatley-Price P , Segal-Nadler R , Verma S , Song X , Kuchuk I , Clemons M 
Published: August 2014

Background: The probability of detecting radiologically evident distant metastatic disease in asymptomatic women with primary operable breast cancer is low. Because of this, evidence-based guidelines have been developed to guide physicians on whom to image. Despite these guidelines, peri-operative staging imaging is frequently over-utilized. Relatively little is known about what patients’ perceptions and expectations are regarding peri-operative imaging and whether or not their views are in concordance with the guidelines. We undertook this study in an attempt to answer this question.

Methods: A questionnaire on peri-operative imaging to look for distant metastatic disease was given to women with early stage breast cancer who had completed their surgery. The survey questions were developed in a collaborative effort amongst oncologists, epidemiologists and knowledge translation experts.

Results: Over a 3 month period, 234 surveys were completed at a large Canadian academic cancer centre. The use of peri-operative imaging to assess the skeleton (e.g. bone scan), thorax (e.g. CT, xray), and abdomen (e.g. CT, MRI or ultrasound) is summarized in Table 1 for the 187 patients (80%) who identified their disease stage.

Patient reported perioperative imaging by disease stage Stage 1Stage 2Stage 3No. of patients (%)82/187 (44%)67/187 (36%)38/187 (20%)Median age (range)59 (29-80)57 (27-77)56 (49-65)Peri-operative imaging done for   Skeleton in (%)41/82 (50%)47/67 (70%)33/38 (87%)Thorax in (%)48/82 (59%)53/67 (79%)30/38 (79%)Abdomen in (%)34/82 (41%)42/67 (63%)27/38 (71%)

The relative proportion of patients undergoing imaging increased with advancing stage. Of the 187 patients, 66% indicated they would want imaging if the chance of finding metastatic disease was ≤10% and half of these patients (i.e. 33%) indicated they would want imaging if the chance was &lt;1%. The most common factors identified as being either extremely (EI) or very important (VI) by patients were: catching the spread of cancer to other parts of the body early (93%), reducing the chance of dying (90%), and providing peace of mind (77%). Avoiding inconvenience, exposure to scans, and extra imaging that will not change length or quality of life, and false alarms were EI or VI in ∼50%. Perceptions of these factors did not differ across disease stage. Although 85% indicated doing whatever their doctor recommended was either EI or VI to them, 72% indicated that they would feel very or somewhat uncomfortable if their physician did not order imaging to look for metastatic disease, even if this was in keeping with the guideline recommendation.

Conclusion: Irrespective of evidence-based guidelines, many patients undergo peri-operative imaging. While guidelines tend to address physician behaviour it is evident that patient perceptions and expectations are divergent from the evidence-based guidelines. If patient expectations are, in part, driving excessive imaging, new strategies targeting patient expectations and knowledge are required.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-01.