Discussion of treatment options for early-stage breast cancer: Effect of provider specialty on type of surgery and satisfaction

OBJECTIVES. To describe the physicians with whom breast cancer patients dis cuss treatment options and assess whether discussing surgical options with a medical oncologist is associated with type of surgery and satisfaction. RESEARCH DESIGN. Medical record abstraction and survey. SUBJECTS. Women With early-stage breast cancer numbering 2,426 in two state s - Massachusetts, where the rate of breast-conserving surgery is high, and Minnesota, where it is lower. MEASURES. Receipt of breast-conserving surgery and satisfaction. RESULTS. Women in Massachusetts discussed breast cancer treatments with mor e physicians than women in Minnesota (mean 3.5 vs. 2.8; P <0.001) and more often discussed surgical options with a medical oncologist (52% vs. 28%; P <0.001). Using propensity score analyses, in Massachusetts, discussing surg ical options with a medical oncologist was not related to type of surgery ( adjusted difference in rate of breast-conserving surgery: 3.9%, 95% CI -3.6 % to 11.5%) but was associated with greater satisfaction (adjusted differen ce: 8.1, 95% CI 2.0% to 14.2%). In Minnesota, discussing surgical options w ith a medical oncologist was associated with breast-conserving surgery (adj usted difference: 12.6%, 95% CI 5.6% to 19.7%) with no difference in satisf action (adjusted difference: -1.5%, 95% CI -6.8% to 3.8%). CONCLUSIONS. Outcomes associated with discussing surgical treatments with a medical oncologist vary with local care patterns. Where breast-conserving surgery is standard care, seeing a medical oncologist is not related to typ e of surgery, but is associated with greater satisfaction. Where it is not the standard, seeing a medical oncologist is associated with more breast-co nserving surgery and equivalent satisfaction. These findings suggest that c ollaborative care may benefit women with respect to treatment selection or satisfaction.