Physician Sex and Other Factors Associated With Type of Breast Cancer Surgery in Older Women

Abstract

Hypothesis: Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women, despite National Institutes of Health recommendations favoring lumpectomy over mastectomy.Design: A descriptive and analytical retrospective computer-assisted telephone survey.Setting: A population-based random sample of breast cancer survivors in Colorado, identified from the Colorado Central Cancer Registry.Patients: Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer, treated 1 to 6 years previously with mastectomy or lumpectomy, and without recurrence or second primary cancers. Among women contacted, 58% participated. Results of 198 interviews are reported.Methods: Survey questions included patient decisionmaking participation and physician recommendations, sources and amount of treatment information provided by physicians, physician characteristics, and patient surgery preferences and demographic characteristics. A multivariate logistic regression model identified factors independently associated with lumpectomy.Results: Lumpectomy was strongly associated with higher patient education, female physician sex, patient age 75 years or older, and amount of physician-provided information. The number of physician-provided information sources was associated with surgery explanations, and female physicians provided more sources of information. A physician decision or recommendation for surgery type was reported by 61% of women, of whom 93% underwent the recommended procedure. A subset of patients (13%) reported deferring the surgery decision to someone else. Conclusions:These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type.

Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study

“…What patients thought to be the treatment preference of their physician was found to be the most important predictor of their own treatment preference. Likewise, previous studies also found that physicians are a major factor in the treatment decisions made for breast cancer (Ward et al, 1989;Kotwall et al, 1996;Stafford et al, 1998; Patients' treatment choices for breast cancer S Molenaar et al Cyran et al, 2001;Nold et al, 2001). Patients are often inclined to believe that they lack the knowledge and expertise to decide for themselves, that the physician has additional information not (yet) being shared, and that having confidence in the physician means having confidence in their recommendation (Charavel et al, 2001;Gurmankin et al, 2002).…”

“…Several, mainly North-American studies identified a range of factors influencing breast cancer patients' treatment preferences. For example, age and education were associated with increased BCT use (Cyran et al, 2001;Morrow et al, 2001;Nold et al, 2001;Gilligan et al, 2002;Staradub et al, 2002). In addition, patients' concerns about recurrence, survival, body image and radiation were found to influence treatment preferences (Ward et al, 1989;Kotwall et al, 1996;Stafford et al, 1998;Mastaglia and Kristjanson, 2001;Nold et al, 2001).…”

“…rural vs urban), type of hospital, and availability of radiation facilities (Mastaglia and Kristjanson, 2001;Morrow et al, 2001;Gilligan et al, 2002). Moreover, the preference of the surgeon was a major factor in patients' decision making (Kotwall et al, 1996;Stafford et al, 1998;Cyran et al, 2001;Mastaglia and Kristjanson, 2001;Nold et al, 2001).…”

“…For example, factors influencing decision making in breast cancer have almost exclusively been identified in North-American, retrospective, surveys (Ward et al, 1989;Kotwall et al, 1996;Stafford et al, 1998;Cyran et al, 2001;Mastaglia and Kristjanson, 2001;Morrow et al, 2001;Nold et al, 2001;Gilligan et al, 2002). In these studies, unrecognised factors, patient recall and causality are significant problems.…”

“…Moreover, in the above studies, patients were eligible for BCT and MT on the basis of clinical selection criteria. However, whether patients were explicitly given the opportunity to make a treatment choice was frequently unclear (Stafford et al, 1998;Cyran et al, 2001;Mastaglia and Kristjanson 2001;Morrow et al, 2001;Nold et al, 2001;Gilligan et al, 2002). In addition, in the above studies, the type and amount of patient education given to patients was frequently not specified.…”