Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study

Abstract

Patients are increasingly involved in cancer treatment decisions and yet little research has explored factors that may affect patient attitudes and beliefs about their therapeutic choices. This paper examines psychosocial factors (e.g., attitudes, social support), provider-related factors (e.g., communication, trust), and treatment considerations in a prospective study of a sample of early stage breast cancer patients eligible for chemotherapy and/or hormonal therapy (BQUAL cohort). The data comes from a multi-site cohort study of white, black, Hispanic, and Asian non-metastatic breast cancer patients recruited in New York City, Northern California, and Detroit Michigan. Baseline surveys were conducted over the telephone between 2006 and 2010 among a total of 1145 women. Most participants were white (68%), had more than a high school education (76%), and were diagnosed with stage I disease (51%). The majority of women reported discussing chemotherapy and hormonal therapy with their doctor (90% and 83% respectively); these discussions primarily took place with medical oncologists. Nearly a quarter of women reported that the treatment decision was difficult and the majority were accompanied to the doctor (76%) and involved a friend or family member in the decision (54%). Positive considerations (e.g., beliefs about treatment reducing risk of recurrence) were important in making treatment decisions. Participants preferred a shared decision-making style, but results suggested that there is room for improvement in terms of actual patient involvement in the decision and provider communication, particularly among black patients. Patients 65 years and older reported fewer provider discussions of chemotherapy, poorer patient-provider communication, higher rates of being assisted by family members in making the decision, and more negative attitudes and beliefs towards treatment.

Older Women Breast Cancer Survivors: Decision Making, Sources of Information and Wellness Activities in Malaysia

“…Results from the study shows that older breast cancer patients made treatment decisions on their own. This finding is inconsistent with a previous study who found that older breast cancer patients were more comfortable to leave the treatment decisions to the physician or assume a less active role in making treatment decisions (Pinquart and Duberstein, 2004;Gaston and Mitchell, 2005;Almyroudi et al, 2010;Shelton et al, 2012).…”

“…The reasons were that (1) patients did not know enough about breast cancer, (2) they believe that doctors were the experts, (3) they felt unqualified to make judgments about medical problems, and (4) patients may have difficulty in understanding physicians' terminology (Maly, 2004). Besides health professionals, family members also play an important role in assisting cancer patients make decisions on treatment, especially patients 65 years and older (Shelton et al, 2012). A review of literature on decision-making and information provision in patients with advanced cancer pointed out that those who took an active role were younger and had a higher education level (Gaston and Mitchell, 2005).…”

Diagnosis and Surgical Delays in African American and White Women with Early-Stage Breast Cancer

“…This finding supports emerging evidence that a combination of both clinical and nonclinical factors play an important role throughout the continuum of BC care delivered to AA women. 40 Our study has several limitations. The participation rate for older women was poorer than in younger women.…”

Racial/Ethnic and Socioeconomic Disparities in Endocrine Therapy Adherence in Breast Cancer: A Systematic Review

“…These 5 studies included publicly insured patients who were enrolled in state Medicaid programs 19,60,81,87 or Medicare’s low-income subsidy program. 22 Of all included articles, 6 77,78,80,81,83,86 examined primary data collected through the use of surveys, interviews, or focus groups; of these, 3 77,80,83 included self-reported barriers to care (Table 2). Eight studies 19,22,60,79,82,83,85,87 used large secondary data sources or medical records to examine racial/ethnic and socioeconomic disparities in ET use; of these, 3 77,79,86 examined adjuvant breast cancer therapy broadly, including not only ET use but also either chemotherapy, or chemotherapy with radiation therapy.…”

“…22 Of all included articles, 6 77,78,80,81,83,86 examined primary data collected through the use of surveys, interviews, or focus groups; of these, 3 77,80,83 included self-reported barriers to care (Table 2). Eight studies 19,22,60,79,82,83,85,87 used large secondary data sources or medical records to examine racial/ethnic and socioeconomic disparities in ET use; of these, 3 77,79,86 examined adjuvant breast cancer therapy broadly, including not only ET use but also either chemotherapy, or chemotherapy with radiation therapy. Although these studies evaluated chemotherapy and radiation therapy as dependent variables, some studies included these treatment variables (i.e., surgery, chemotherapy, radiation) as predictor variables of ET use 19,22,60,81,82,84,87 and other studies 78,80,83 , did not include treatment variables in their analyses.…”