Primary care provider–reported involvement in breast cancer treatment decisions

Wallner, Lauren P.; Li, Yun; McLeod, M. Chandler; Gargaro, Joan; Kurian, Allison W.; Jagsi, Reshma; Radhakrishnan, Archana; Hamilton, Ann S.; Ward, Kevin C.; Hawley, Sarah T.

doi:10.1002/cncr.31998

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…In a recent study that included 517 women diagnosed with early stage breast cancer, Wallner at al. found that up to one-third of PCPs reported involvement in multimodal breast cancer treatment decisions [15]. Moreover, older PCPs and those who more positively evaluated their ability to participate in cancer treatment decision making were more likely to participate [15].…”

Section: Discussionmentioning

confidence: 99%

Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

et al. 2019

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BackgroundPrimary care providers (PCPs) have always played an important role in cancer diagnosis. There is increasing awareness of the importance of their role during treatment and survivorship. We examined changes in PCP utilization from pre-diagnosis to survival for women diagnosed with breast cancer, factors associated with being a high user of primary care, and variation across four Canadian provinces.MethodsThe cohorts included women 18+ years of age diagnosed with stage I-III invasive breast cancer in years 2007–2012 in British Columbia (BC), Manitoba (MB), Ontario (ON), and Nova Scotia (NS) who had surgery plus adjuvant chemotherapy and were alive 30+ months after diagnosis (N = 19,589). We compared the rate of PCP visits in each province across phases of care (pre-diagnosis, diagnosis, treatment, and survival years 1 to 4).ResultsPCP use was greatest during treatment and decreased with each successive survival year in all provinces. The unadjusted difference in PCP use between treatment and pre-diagnosis was most pronounced in BC where PCP use was six times higher during treatment than pre-diagnosis. Factors associated with being a high user of primary care during treatment included comorbidity and being a high user of care pre-diagnosis in all provinces. These factors were also associated with being a higher user of care during diagnosis and survival.ConclusionsContrary to the traditional view that PCPs focus primarily on cancer prevention and early detection, we found that PCPs are involved in the care of women diagnosed with breast cancer across all phases of care.

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Section: Discussionmentioning

confidence: 99%

Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

et al. 2019

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“…The results of the study showed that after the first intervention, the symptoms of breast pain and swelling in the intervention group were significantly lower than those in the control group. Researchers found that exercise or physical activity not only helps to reduce the symptoms of chemotherapy and digestive tract, but also has a significant effect on breasts and affected limbs of breast cancer patients ( 23 ). Based on this point of view, the perceptual stress reduction control intervention exercises the whole-body muscle to the affected limb.…”

Section: Discussionmentioning

confidence: 99%

Effect of Perceptual Stress Reduction Control Intervention on the Level of Symptoms in Breast Cancer at Different Time Points

Cao¹,

Li²,

Wang³

et al. 2020

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Background: To investigate the effect of perceptual stress reduction control intervention on the level of symptomatic groups at different time points in breast cancer. Methods: A total of 124 breast cancer patients were divided into intervention group and control group, 62 cases in each group. Perioperative nursing and chemotherapy nursing were given to the control group, and the intervention group was given the interventional stress reduction control intervention. The level of symptom clusters of different time points were compared between the two groups. Results: The incidence and severity of myelosuppression in the intervention group were slightly lower than those in the control group. The adverse reactions of bone marrow suppression at T3 were much lower than those in the control group, and the differences were significant (P=0.003, P=0.043). The control group had higher incidence and more severe symptoms of nausea, vomiting and diarrhea than the intervention group (P=0.002, P=0.042). The symptoms of breast pain and swelling at T1 in the intervention group were significantly lower than those in the control group (P=0.000, P=0.000). There was no significant difference in breast symptoms between the two groups at T2 and T3 (p>0.05). At the time of T2 and T3 of chemotherapy, the health promotion behavior scores of the intervention group were higher than the control group, and the difference was statistically significant (PT2=0.000, PT3=0.000). Conclusion: Perceptual stress reduction control intervention can effectively relieve bone marrow suppression, digestive tract discomfort and breast symptoms, and promote health promotion behavior.

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“…Survey content was developed based on prior work, modifying measures used by our team on previous surveys, and pilot testing with urologists and PCPs. 3,17,18 PCP Confidence in Treatment Decision-making.…”

Section: Methodsmentioning

confidence: 99%

“…While PCP involvement during survivorship has flourished due to the increasing national emphasis on team-based cancer care delivery, recent research suggests that patients are involving their PCPs during the treatment stage. [1][2][3][4][5] In particular, patients are discussing their initial cancer treatment options with their PCPs in addition to their cancer specialists (e.g., medical oncologist, radiation oncologist, or surgeon). Work by our team found that, in a population-based cohort of women with early-stage breast cancer, over a third of women and their PCPs reported participation by their PCP in their treatment decision-making.…”

Section: Introductionmentioning

confidence: 99%

“…Work by our team found that, in a population-based cohort of women with early-stage breast cancer, over a third of women and their PCPs reported participation by their PCP in their treatment decision-making. 3,4 An area with great potential to leverage the role of PCPs is in the management of low-risk cancers. Due to the indolent nature of these cancers, treatment is evolving from surgery or radiation to active surveillance, which involves routine followup with clinical exams and lab tests and/or imaging.…”

Section: Introductionmentioning

confidence: 99%

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Primary Care Providers’ Perceptions About Participating in Low-Risk Prostate Cancer Treatment Decisions

et al. 2020

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BACKGROUND: Primary care provider's (PCP) role in cancer care is expanding and may include supporting patients in their treatment decisions. However, the degree to which PCPs engage in this role for low-risk prostate cancer is unknown. OBJECTIVE: Characterize PCP perceptions regarding their role in low-risk prostate cancer treatment decisionmaking. DESIGN: Cross-sectional, national survey. MAIN MEASURES: For men with low-risk prostate cancer, PCP reports of (1) confidence in treatment decisionmaking (high vs. low); (2) intended participation in key aspects of active surveillance treatment decision-making (more vs. less). KEY RESULTS: A total of 347 from 741 eligible PCPs responded (adjusted response rate 56%). Half of respondent PCPs (50.3%) reported high confidence about engaging in low-risk prostate cancer treatment decision-making. The odds of PCPs reporting high confidence were greater among those in solo practice (vs working with > 1 PCP) (OR 2.18; 95% CI 1.14-4.17) and with higher volume of prostate cancer patients (> 15 vs. 6-10 in past year) (OR 2.16; 95% CI 1.02-4.61). PCP report of their intended participation in key aspects of active surveillance treatment decision-making varied: discussing worry (62.4%), reviewing benefits (48.5%) and risks (41.8%), and reviewing all treatment options (34.2%). PCPs who reported high confidence had increased odds of more participation in all aspects of active surveillance decision-making: reviewing all treatment options (OR 3.11; 95% CI 1.82-5.32), discussing worry (OR 2.12; 95% CI 1.28-3.51), and reviewing benefits (OR 3.13;) and risks (OR 3.20;. CONCLUSIONS: The majority of PCPs were confident about engaging with patients in low-risk prostate cancer treatment decision-making, though their intended participation varied widely across four key aspects of active surveillance care. With active surveillance being considered for other low-risk cancers (such as breast and thyroid), understanding factors influencing PCP involvement will be instrumental to supporting teambased cancer care.

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Primary care provider–reported involvement in breast cancer treatment decisions

Cited by 14 publications

References 22 publications

Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

Changes in primary care provider utilization by phase of care for women diagnosed with breast cancer: a CanIMPACT longitudinal cohort study

Effect of Perceptual Stress Reduction Control Intervention on the Level of Symptoms in Breast Cancer at Different Time Points

Primary Care Providers’ Perceptions About Participating in Low-Risk Prostate Cancer Treatment Decisions

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