Journal of the National Cancer Institute Advance Access originally published online on August 31, 2009
JNCI Journal of the National Cancer Institute 2009 101(19):1337-1347; doi:10.1093/jnci/djp271
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author 2009. Published by Oxford University Press.
ARTICLES |
Decision Involvement and Receipt of Mastectomy Among Racially and Ethnically Diverse Breast Cancer Patients
Affiliations of authors: Division of General Medicine, Department of Internal Medicine (STH, BS, SJK), Division of Hematology and Oncology (JeJG) and Department of Radiation Oncology (RJ), University of Michigan Health System, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (STH, SJK); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Wayne State University and Karmanos Cancer Institute, Detroit, MI (JoJG); Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI (NKJ); Memorial Sloan Kettering Cancer Center, New York, NY (MM)
Correspondence to: Sarah T. Hawley, PhD, MPH, Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 N. Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429 (e-mail: sarahawl{at}med.umich.edu).
Background: Few studies have evaluated the association between patient decision involvement and surgery received among racially and ethnically diverse patients or patients’ attitudes about surgery and the role of family and friends in surgical treatment choices.
Methods: Women diagnosed with nonmetastatic breast cancer from June 2005 through February 2007 and reported to the Los Angeles or Detroit Surveillance, Epidemiology, and End Results registries were mailed a survey after diagnosis (N = 3133). Latina and African American women were oversampled. The response rate was 72.4%. The analytic sample (N = 1651) excluded those with stage IIIA or higher disease, self-reported clinical contraindications to breast-conserving surgery with radiation, and unclear race or ethnicity. The dependent variable was receipt of mastectomy initially. The primary independent variables were patient involvement in decision making, race or ethnicity, attitudes about recurrence, the effects of radiation, the impact of surgery on body image, and the role of others in decision making. Latinas were categorized as low or high acculturated. The association between patient involvement in decision making and the receipt of mastectomy was evaluated using logistic regression while controlling for other independent variables. All statistical tests were two-sided.
Results: The analytic sample was 23.9% Latina (12.0% low acculturated, 11.9% high acculturated), 27.1% African American, and 48.9% white, and 17.2% received a mastectomy initially. For each racial or ethnic group, more women who reported a patient-based decision received mastectomy than those who reported a shared or surgeon-based decision (P = .022 for low-acculturated Latinas, P < .001 for other groups). Women who reported that concerns about recurrence or radiation effects were very important in their surgery decision were more likely to receive mastectomy than those less concerned (for recurrence concerns, estimated relative risk [RR] = 1.66, 95% confidence interval [CI] = 1.28 to 2.10; for radiation concerns, estimated RR = 2.35, 95% CI = 1.88 to 2.85). Women who reported that body image concerns and their spouse's opinion were very important in their surgery decision less often received mastectomy than those less concerned about body image or who placed less weight on their spouse's opinion (for body image concerns, estimated RR = 0.47, 95% CI = 0.30 to 0.74; for spouse's opinion, estimated RR = 0.53, 95% CI = 0.36 to 0.78).
Conclusion: Greater patient involvement in decision making was associated with receipt of mastectomy for all racial and ethnic groups. Patient attitudes about surgery and the opinions of family and friends contribute to surgical choices made by women with breast cancer.
| CONTEXT AND CAVEATS Prior knowledge Although variation in patient involvement in breast cancer surgical treatment decisions exists, few studies have evaluated the association between patient decision involvement and receipt of surgery among racially and ethnically diverse patients or patients’ attitudes about surgery and the role of family and friends in surgical treatment choices. Study design Women diagnosed with nonmetastatic breast cancer from June 1, 2005, through February 1, 2007, who were reported to the Surveillance, Epidemiology, and End Results registries in the Los Angeles and Detroit metropolitan areas were mailed a survey soon after diagnosis to ascertain the degree of patient involvement in decision making, race or ethnicity, attitudes about disease recurrence, the effects of radiation, and the impact of surgery on body image and the role of friends and family in decision making. Latina and African American women were oversampled. Contribution Greater patient involvement in decision making was associated with greater receipt of mastectomy in all racial and ethnics groups. Women who reported that concerns about recurrence or the effects of radiation were very important in their treatment decision making were more likely to receive mastectomy initially than those who were less concerned, whereas those who reported that concern about body image and their spouse's opinion were very important factors in their surgery decision were less likely to receive mastectomy initially than those who were less concerned or placed less weight on their spouse's opinion. Implications Patient attitudes about surgery as well as the opinions of family and friends contribute to surgical choices made by women with breast cancer. Limitations Patient involvement was self-assessed and may be subject to recall bias. The results may not be generalizable to all women with breast cancer. Some measures, such as decision involvement and patient attitudes, have not been validated in Spanish-speaking populations. From the Editors
|
Manuscript received January 19, 2009; revised July 6, 2009; accepted July 16, 2009.
Related Article in JNCI
CiteULike 
Connotea 
Del.icio.us What's this?
J Natl Cancer Inst 2009 101: 1293.
This article has been cited by other articles:
|
|
 |
|
  M. Morrow, R. Jagsi, A. K. Alderman, J. J. Griggs, S. T. Hawley, A. S. Hamilton, J. J. Graff, and S. J. Katz Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer JAMA, October 14, 2009; 302(14): 1551 - 1556. [Abstract] [Full Text] [PDF]
|
|