Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery

Whelan, Timothy J.; Levine, Mark; Willan, Andrew R.; Gafni, Amiram; Sanders, Ken; Mirsky, Doug; Chambers, Shelley; O’Brien, Mary Ann; Reid, Susan; Dubois, Sacha

doi:10.1001/jama.292.4.435

Cited by 372 publications

(364 citation statements)

References 35 publications

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“…These strategies must also consider the individual providers and their beliefs and biases. Efforts to reduce provider bias could potentially include improved patient or physician education (49) and implementation of shared decision-making tools (50,51). Reimbursement reform represents a clear but complex measure that has the capacity to influence patterns of care.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Boero

Gillespie

Hou

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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SummaryThis study evaluated the impact of radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Using SEERMedicare data and multilevel, multivariable logistic models, we assessed the impact of radiation oncologist and geographic practice area on the likelihood of receiving hypofractionated radiation therapy. The key finding of our study was that the individual radiation oncologist heavily influenced the decision to pursue hypofractionation.Purpose: Despite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Methods: We identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy. Results: Among the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2. Radiation OncologyInternational Journal of biology physics www.redjournal.org long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05). Conclusions: The individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision. Ó

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Section: Discussionmentioning

confidence: 99%

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Boero

Gillespie

Hou

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…Conversely, if the NAC has to be sacrificed, a two-stage reconstruction with the placement of a skin expander is generally preferable [22,23]. Furthermore, it is well known that exhaustive preoperative information may significantly influence the choices of breast cancer patients on their favourite type of surgery [24] and reduce their feelings of regret and dissatisfaction with the operation [25].…”

Section: Discussionmentioning

confidence: 99%

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Ponzone

Carabalona

Rivolin

et al. 2015

European Journal of Cancer

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Background: Nipple-areola sparing mastectomy (NSM) with immediate implant reconstruction is an option for patients with non-locally advanced breast cancer. The prediction of occult tumour involvement of the nipple-areola complex (NAC) may help select candidates to NSM. Patients and methods: We prospectively recorded clinical and pathological data, magnetic resonance imaging (MRI) results and intraoperative pathological assessments of the subareolar (SD) and proximal nipple ducts (ND) of 112 consecutive breast cancer patients scheduled for NSM. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. Results: Thirty-one patients (27.7%) had tumour involvement of the NAC. At univariate analysis, age (p = 0.001), post-menopausal status (0.003), tumour central location (p = 0.03), tumour-NAC distance measured by MRI (p = 0.000) and intraoperative pathologic assessment (SD + ND) (p = 0.000) were significantly correlated with NAC involvement. At multivariate analysis, only MRI tumour-NAC distance (p = 0.008) and menopausal status (p = 0.039) among all preoperative variables retained statistical significance. The sensitivity and specificity of MRI tumour-NAC distance were 32.2% and 88.6% and those of E-mail address: riccardo.ponzone@ircc.it (R. Ponzone).European Journal of Cancer (2015) 51, 1882-1889 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m intraoperative pathologic assessment were 46.7% and 100%, respectively. Sensitivity, specificity and accuracy of the double assessment (MRI plus intraoperative pathology) were 50.0%, 96.2% and 84.1%, respectively. Conclusion: Intraoperative pathologic assessment and tumour-NAC distance measured by MRI are the most important predictors of occult NAC involvement in breast cancer patients. A negative pathological assessment and a tumour-NAC distance P 5 mm allow optimal discrimination between NAC positive and NAC negative cases and may serve as a guide for the optimal planning of oncological and reconstructive surgery.

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“…1,[6][7][8][9][10][11][12][13][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] The patients' expectations also depend on the type of the disease, 15,20 or the type of the malignancy. 13,15,19,25 Most of the literature data on the attitude of breast cancer patients towards being informed, and participation in treatment decision come from Canada, 15,17,18,26,32 the US, 7,10,25,[27][28][29][30][31]34 Australia, 6,9,…”

Section: Discussionmentioning

confidence: 99%

“…Thus, information tools, like a breast cancer CD-ROM, 36 a breast cancer decision board 17,18 and a pre-consultation intervention session 29 were successfully applied. We used a question prompt sheet developed by Brown et al, 6 which helped the patients to get prepared for the consultation.…”

mentioning

confidence: 99%

Collaborative/active participationper se does not decrease anxiety in breast cancer

Kahán

Varga

Dudás

et al. 2006

Pathol. Oncol. Res.

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Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery

Cited by 372 publications

References 35 publications

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Collaborative/active participationper se does not decrease anxiety in breast cancer

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