WOMENS USE OF RESOURCES IN DECISION-MAKING FOR EARLY-STAGE BREAST-CANCER - RESULTS OF A COMMUNITY-BASED SURVEY

Background: The majority of women with stage I/II breast cancer may ch oose between mastectomy and breast-conserving therapy (BCT). A survey was designed to examine the resources women used in making this decisi on. Methods: From 1990 to 1994, 261 patients were diagnosed with or tr eated for stage I/II breast cancer at Washington Hospital (Fremont, CA ). One-hundred seventy-six surviving patients received a questionnaire asking them to anonymously rank various medical and nonmedical person s, audio and visual materials, and decision criteria on a 5-point scal e with regard to their influence on that individual's choice to underg o BCT or mastectomy. The BCT and mastectomy groups were similar demogr aphically; similar to 50% were college-educated. Statistical significa nce of the difference in means between groups was assessed with the t test. The response rate to the survey was 65%. Results: The average su rvey ranking was >1.0 for the following: surgeon (4.5), primary care p hysician (2.8), spouse (2.4), radiation oncologist (1.7), medical onco logist (1.5), American Cancer Society brochure (1.4), and children (1. 2). The ranking of children (p = 0.08), friends (p = 0.08), parents (p = 0.09), and spouse (p = 0.13) was higher in the mastectomy group; th e ranking of the radiation oncologist (p = 0.001) and ACS brochure (p = 0.03) was higher in the BCT group. The majority of patients consulte d only with the surgeon (96%), primary care physician (64%), and spous e (55% overall, 75% among married patients) before making a treatment choice. Decision criteria were ranked as follows: chance for cure (4.5 ), physician recommendation (3.7), potential side effects (1.7), cosme tic appearance (1.3), sexual attractiveness (1.1), treatment convenien ce (1.0), and desire to avoid mastectomy (1.5). Desire to avoid mastec tomy was higher in the BCT group (p < 0.0001); ranking of chance for c ure was higher in the mastectomy group (p = 0.12). Overall satisfactio n was higher in the BCT group; 87% of these patients were ''very satis fied'' with their decision versus 68% for the mastectomy group (p = 0. 005). Review of the admitting records for 125 patients treated with ma stectomy indicated that 46% had clear medical or personal contraindica tions to BCT, but that the remainder might have benefitted from specia lty consultation. Conclusions: The surgeon's recommendation and the pa tient's perception of chance for cure were the most influential factor s affecting treatment decision. There was a limited use of specialty c onsultation or written and audiovisual materials in this educated pati ent population. The survey results suggest potential areas of interven tion to improve rates of BCT, namely use of up-front multidisciplinary evaluation, further education of primary care physicians, and greater attention to concerns of family members.