Researchers examined the decision-making processes of patients with breast cancer to understand why a procedure that does not improve survival is increasingly being considered.
Contralateral prophylactic mastectomy, or removal of both breast when cancer is only present in one breast, is a treatment option which over 20% of patients choose. However, most women do not benefit from improved survival as a result of this procedure. Limited research exists regarding how decision styles and values of patients with breast cancer factors in to considering contralateral prophylactic mastectomy at the time of treatment decision-making.
Sarah T Hawley, PhD, MPH, professor of internal medicine, Michigan University, and colleagues surveyed 2578 women with newly-diagnosed, early-stage breast cancer approximately 7 months after surgery. Researchers identified patients who were treated in 2013-2014 through the Surveillance, Epidemiology, and End Results registries in Los Angeles and Georgia. Patients were asked how strongly they considered contralateral prophylactic mastectomy as a treatment option and about their values and decision-making style.
The study was published in Cancer (online August 15, 2017; doi:10.1002/cncr.30924).
Results of the survey showed that almost 25% of respondents reported strong or very strong consideration of contralateral prophylactic mastectomy, while 29% considered the procedure only moderately or weakly.
Furthermore, researchers noted a range of decision-making styles, including anywhere from a rational to an intuitive approach. Factors most valued by women at the time of treatment decision-making included avoiding worry about recurrence (82%) and reducing the need for more surgery (73%).
Multivariate analysis showed that patients who preferred to make their treatment decision regardless of physician advice, those who valued avoiding worry about recurrence, and those who valued avoiding radiation were most likely to strongly consider contralateral prophylactic mastectomy (P < .05). On the contrary, those who reported making a logical treatment decision and those who valued keeping their breast did not strongly consider contralateral prophylactic mastectomy as often.
"If physicians have feedback that a patient likes to make decisions a certain way, they can understand the patient's emotional processing and help the patient make a decision that meets her needs physically and emotionally," said Dr Hawley in an interview (August 15, 2017).—Zachary Bessette