The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population-based sample of breast cancer patients

Authors

  • Sarah T. Hawley PhD, MPH,

    Corresponding author
    1. Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan
    2. Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan
    3. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
    • Corresponding author: Sarah T. Hawley, PhD, MPH, Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI 48109; sarahawl@umich.edu.

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  • Kent A. Griffith MS, MPH,

    1. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Ann S. Hamilton PhD,

    1. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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  • Kevin C. Ward PhD, MPH,

    1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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  • Monica Morrow MD,

    1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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  • Nancy K. Janz PhD,

    1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Steven J. Katz MD, MPH,

    1. Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan
    2. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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    • The last 2 authors contributed equally to this article.

  • Reshma Jagsi MD, DPhil

    1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
    2. Center for Bioethics and Social Science in Medicine, Ann Arbor, Michigan
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    • The last 2 authors contributed equally to this article.


  • We acknowledge the work of our project staff: Mackenzie Crawford, MPH, and Kiyana Perrino, MPH, from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, BA, and Renee Bickerstaff-Magee from the University of Southern California; and Rebecca Morrison, MPH, Alexandra Jeanpierre, MPH, Stefanie Goodell, BS, Irina Bondarenko, MS, and Rose Juhasz, PhD, from the University of Michigan. We also acknowledge with gratitude the breast cancer patients who responded to our survey.

Abstract

BACKGROUND

Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with the consideration of different treatment options and specifically with the consideration of contralateral prophylactic mastectomy (CPM).

METHODS

Newly diagnosed patients with early-stage breast cancer who were treated in 2013-2014 were identified through the Surveillance, Epidemiology, and End Results registries of Los Angeles and Georgia and were surveyed approximately 7 months after surgery (n = 2578; response rate, 71%). The primary outcome was the consideration of CPM (strong vs less strong). The association between patients' values and decision styles and strong consideration was assessed with multivariate logistic regression.

RESULTS

Approximately one-quarter of women (25%) reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including a rational-intuitive approach to decision making, varied. The factors most valued by women at the time of treatment decision making were as follows: avoiding worry about recurrence (82%) and reducing the need for more surgery (73%). In a multivariate analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and those who valued avoiding radiation significantly more often strongly considered CPM (P < .05), whereas those who reported being more logical and those who valued keeping their breast did so less often.

CONCLUSIONS

Many patients considered CPM, and the consideration was associated with both decision styles and values. The variability in decision styles and values observed in this study suggests that formally evaluating these characteristics at or before the initial treatment encounter could provide an opportunity for improving patient clinician discussions. Cancer 2017. © 2017 American Cancer Society.

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