The Quality of Decisions about Adjuvant Chemotherapy for Early Stage Breast Cancer.
Authors: C. Lee, J. Belkora, M. Wetschler, Y. Chang, S. Feibelmann, B. Moy, A. Partridge, K. Sepucha
Journal: Cancer Research (2009)

Abstract Background: Decisions about adjuvant chemotherapy are highly challenging for many women with early stage breast cancer. We sought to assess the quality of breast cancer patients' decisions about chemotherapy by measuring their knowledge and the degree to which their treatment decisions reflect their goals and preferences.Methods: We mailed a survey to early stage (I, II) breast cancer survivors who were treated at one of four sites, as part of a larger study to validate decision quality instruments. A subset of women completed the chemotherapy module, which included questions about the patient-provider interaction, about facts, about treatment goals, and about the patient's preferred treatment. Characteristics associated with knowledge were identified with linear regression. Characteristics associated with chemotherapy were identified with logistic regression.The percentage of patients who received their preferred treatment was calculated.Results: 358 patients completed the survey (response rate 59%). 64% of patients had Stage I disease, and 57% had chemotherapy. Average age was 56.9 years, 82.6% were white, and 63.7% had a college degree.Decision making: 70% of patients reported that their provider mentioned chemotherapy as an option. 43% reported that their provider asked for their preference about chemotherapy. 23% said the doctor mainly made the decision, 29% said they mainly made the decision, and 46% said both made the decision.Most women (92%) felt their level of involvement was about right.Knowledge: The mean knowledge score was 39.6% (SD 20.3). 29.9% knew that less than half of women with early stage breast cancer eventually die from breast cancer without chemotherapy or hormone therapy.21.8% knew that more than half are free from recurrence in 10 years without chemotherapy or hormone therapy. Chemotherapy treatment and the doctor having discussed chemotherapy were significantly associated (p&amp;lt;0.05) with higher knowledge. Younger age at diagnosis, white race, higher income, and a college degree were also significantly associated with higher knowledge (p&amp;lt;0.05).Treatment: Factors associated with having chemotherapy were younger age (OR 1.71, 95% CI 1.01, 2.91) and not having hormone therapy (OR 3.2, 95% CI 1.92, 5.42). Factors associated with not having chemotherapy were lower stage (OR 0.17, 95% CI 0.10, 0.30), mastectomy (OR 0.47, 95% CI 0.26, 0.86), and the goal “live as long as possible” (OR 1.41, 95% CI 1.10, 1.80).Concordance with preferences: 81.6% of patients who preferred chemotherapy received it, and 92.6% of patients who preferred no chemotherapy received no chemotherapy.Conclusion: Breast cancer patients had substantial knowledge deficits about chemotherapy, which were even more prevalent among older, non-white, less educated, and lower-income women. In addition, more than half of women reported they were not asked about their preferences, and some reported getting chemotherapy treatment that was not concordant with their preferences.Oncologists should address knowledge deficits and explicitly ask patients their preferences. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2083.