Adherence to Recommended Treatments for Early Invasive Breast Cancer: Decisions of Women Attending Surgeons in the Breast Cancer Audit of Australia and New Zealand

Abstract

Aim: The study aim was to determine the frequency with which women decline clinicians' treatment recommendations and variations in this frequency by age, cancer and service descriptors. Design: The study included 36,775 women diagnosed with early invasive breast cancer in 1998-2005 and attending Australian and New Zealand breast surgeons. Rate ratios for declining treatment were examined by descriptor, using bilateral and multiple logistic regression analyses. Proportional hazards regression was used in exploratory analyses of associations with breast cancer death. Results: 3.4% of women declined a recommended treatment of some type, ranging from 2.6% for women under 40 years to 5.8% for those aged 80 years or more, and with parallel increases by age presenting for declining radiotherapy (p<0.001) and axillary surgery (p=0.006). Multiple regression confirmed that common predictors of declining various treatments included low surgeon case load, treatment outside major city centres, and older age. Histological features suggesting a favourable prognosis were often predictive of declining various treatments, although reverse findings also applied with women with positive nodal status being more likely to decline a mastectomy and those with larger tumours more likely to decline chemotherapy. While survival analyses lacked statistical power due to small numbers, higher risks of breast cancer death were suggested, after adjusting for age and conventional clinical risk factors, (1) for women not receiving breast surgery for unstated reasons (RR=2.29; p<0.001); and (2) although not approaching statistical significance p≥ 0.200), for women declining radiotherapy (RR=1.22), a systemic therapy (RR1.11), and more specifically, chemotherapy (RR=1.41). Conclusions: Women have the right to choose their treatments but reasons for declining recommendations require further study to ensure that choices are well informed and clinical outcomes are optimized.

Epidemiologic evidence of slow growing, nonprogressive or regressive breast cancer: A systematic review

“…Twenty studies (22 articles) were included . Four of these have been included using also data reported in the Johnstone review .…”

“…Among the included studies, five were cohort studies where the exposed and the nonexposed subjects came from the same population …”

“…Roder 2012 identified 1246 (3.4%) patients declining treatment (surgery or radiotherapy or systemic therapy) out of 36,775 diagnosed in 1998–2005, as recorded in the Audit database of the National Death Index (Australia).…”

Adherence to Capecitabine Treatment and Contributing Factors among Cancer Patients in Malaysia

“…Due to these challenges, patients with poor adherence may not receive the full benefit of treatment and may consequently experience suboptimal outcomes, poor survival rates, potential adverse events and increase cost burden related to hospitalization (Ruddy et al, 2009). A large Australian and New Zealand data reported that 3.4% women with early invasive breast cancer declined clinicians' treatment recommendations and 23.6% of them declined chemotherapy (Roder et al, 2012).…”

Bcl-2 Gene Expression in Human Breast Cancers in Iran

“…Breast cancer is amongst the five most common cancers and ranks first among cancers diagnosed in Iranian women, comprising 24.4% of all malignancies with the mean age ranging from 47.1 to 48.8 years (Ferlay et al, 2012;Roder et al, 2012). Although the incidence of breast cancer is still relatively low when compared with western countries (Iran: 23.65 per 100,000 and United States: 140.8 per 100,000 Caucasian women), the number of patients with newly diagnosed breast cancer are increasing (Harirchi et al, 2011).…”