The influence of patients' concerns on surgeons' recommendations for earlybreast cancer

This paper examines whether an older patient's concerns about surgical trea tment of breast cancer-such as fear of dying or about losing a breast-affec t the treatment recommendations by their surgeons. A sample of 137 older wo men diagnosed with early stage breast cancer between 1994 and 1996 were int erviewed within 2 months of diagnosis to determine demographic characterist ics, their attitudes about breast cancer treatments, and which surgical tre atment their surgeon initially recommended. The treatment preferences of th e 35 surgeons treating these women were ascertained by asking them what tre atment they would usually recommend to a hypothetical 75-year-old woman wit h early stage breast cancer. Patients who reported their feelings about los ing a breast as 'very important' were less likely to be recommended mastect omy (Odds Ratio (OR) = 0.39; 95% (Confidence Interval) CI 0.16, 0.94), whil e patients who reported fear of dying from breast cancer as 'very important ' were more likely to be recommended mastectomy (OR = 4.60; 95% CI 1.94, 11 .59), after adjusting for surgeons' age and the surgeons' treatment prefere nce when presented with a hypothetical patient. It is concluded that surgeo ns integrate patients' attitudes and concerns into their treatment recommen dations.