Psychological effects of being offered choice of surgery for breast cancer

Fallowfield, Lesley; Hall, Angela; Maguire, Peter; Baum, Michael; A’Hern, Roger

doi:10.1136/bmj.309.6952.448

Cited by 191 publications

(107 citation statements)

References 2 publications

(1 reference statement)

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“…Further to granting patients' greater autonomy and control over their care, there is some evidence that SDM improves patient outcomes, such as decisional conflict, satisfaction, and psychological adjustment [5,6]. However, research indicates that SDM accounts for only a small amount of variance in some of these outcomes [7], and is not always practical, or desired by patients [8,9].…”

Section: Introductionmentioning

confidence: 99%

Sharing vs. caring—The relative impact of sharing decisions versus managing emotions on patient outcomes

Smith¹,

Juraskova²,

Butow³

et al. 2011

Patient Education and Counseling

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Section: Introductionmentioning

confidence: 99%

Sharing vs. caring—The relative impact of sharing decisions versus managing emotions on patient outcomes

Smith¹,

Juraskova²,

Butow³

et al. 2011

Patient Education and Counseling

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“…In one study of women with breast cancer, those who were satisfied with the way in which the surgeon discussed their diagnosis and treatment options evidenced less psychiatric morbidity during the first year post treatment and at 2 and 3 year follow up Fallowfield and Hall, 1994). If psychological problems are recognized by healthcare professionals then patients can be referred on for appropriate and effective interventions (Fallowfield, 1995).…”

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confidence: 99%

Psychiatric morbidity and its recognition by doctors in patients with cancer

et al. 2001

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Summary Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. http://www.bjcancer.com oncologists as in the patients whom they treat (Whippen and Canellos, 1991;Ramirez et al, 1995). Approximately 29% of British oncologists had above threshold scores (Ramirez et al, 1996) on a psychiatric screening inventory (GHQ12) (Goldberg and Williams, 1988). The under-trained, over-stretched and underresourced doctor is unlikely to actively elicit information about the psychosocial impact that cancer and its treatment exerts on patients.We report data from a study establishing the prevalence of probable psychiatric morbidity in a heterogeneous sample of 2297 patients with cancer seen in cancer clinics throughout the UK. We also report the ability of their doctors to detect this morbidity and the characteristics of both patient and doctor that were associated with detection. METHODS143 doctors from 34 different cancer centres and hospitals in the UK took part in the study. All were participating in a randomized trial of a communication skills training programme for cancer specialists or specialists in training. Data about psychological morbidity and its recognition were collected as an outcome measure in part of the main trial. The specialty, seniority and sex of doctors are shown in Table 1. Participants included clinical, medical or surgical oncologists, 2 chest physicians who dealt primarily with lung cancer, a dermatologist with a specialist interest in melanoma and a palliative care physician.2681 consecutive patients, waiting in out-patient clinics, were invited to join the main communication skills trial; of these 2331 (85%) gave their written consent to participate. The demographic characteristics of the 2297 patients with completed questionnaires for the detection of psychological morbidity study are shown in Table 2. ProcedurePrior to seeing the doctor con...

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“…The only available quality of life data suggests that in one study, 3 months after the start of treatment, the surgery group had more psychosocial morbidity (P ¼ 0.03), but that there was no difference between the two groups at 2 years (Fallowfield et al, 1994).…”

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confidence: 99%

Have we been guilty of ageism in the primary treatment of breast cancer?

Pritchard

2007

Br J Cancer

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The current issue of the British Journal of Cancer contains a wellconducted meta-analysis of six small randomised trials comparing appropriate surgery, with or without tamoxifen to tamoxifen alone as primary treatment for elderly women with operable breast cancer. The meta-analysis included 517 women treated in studies of surgery plus tamoxifen compared to tamoxifen alone, and 247 women treated in studies of surgery compared to tamoxifen alone. A meta-analysis of each subgroup showed significant improvement in progression-free survival (hazard ratio (HR) ¼ 0.55; 95% confidence interval (CI) 0.39 -0.77; P ¼ 0.006) for surgery in comparison to adjuvant tamoxifen and 0.65 (95% CI 0.53 -0.81; P ¼ 0.0001) for surgery plus tamoxifen in comparison to tamoxifen alone. Overall survival was not improved in the meta-analysis of surgery alone compared to tamoxifen alone, but was marginally significantly better for adjuvant tamoxifen plus surgery compared to adjuvant tamoxifen alone (HR ¼ 0.86; 95% CI, 0.83 -1; P ¼ 0.06). Interestingly, a previous meta-analysis by Mustacchi et al (1994) also suggested a marginally improved risk ratio of 0.86 (P ¼ 0.09) for adjuvant tamoxifen and surgery in comparison to tamoxifen alone for overall survival and 0.70 (Po0.05) for breast cancerrelated survival.The paradigm that women aged 70 and over might receive primary treatment for breast cancer with tamoxifen or other endocrine therapy alone, based on the concept that they are less fit for surgery because of age and co-morbidity, was developed in the 1980s and has been since then considered appropriate to a greater or lesser degree in various countries. Particularly in the United Kingdom, this approach, apparently, has been used in as many as 42% of women in this age group regardless of whether co-morbidity was present or not (Wyld et al, 2004).This meta-analysis however, and that previously published by Mustacchi, as well as a re-examination of the life expectancy of women in their 70s today, would suggest that to approach these women differently from their younger sisters may be quite inappropriate.In fact, the annual incidence of breast cancer increases with age, and divided by decade, more women are diagnosed with breast cancer in the combined decades of their 70s and 80s than in their 50s or their 60s. Unfortunately, most studies of breast cancer therapy worldwide have, at least until recently, specifically excluded women over 70 or even over 65, in itself a form of ageism.In addition, physicians often tend to underestimate life expectancy in elderly women. Although the life expectancy of women born today in most countries of the developed world is well over 70, women who have already reached their 70s are of course likely to live to be even older. Today in Canada, the average life expectancy for a woman of 70 without particular morbidity is more than 16 years and that for a 75-year-old is almost 13 years (Ottawa, 2006). The median time to progression in women in the studies included in this meta-analysis who received only endocrine t...

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Psychological effects of being offered choice of surgery for breast cancer

Cited by 191 publications

References 2 publications

Sharing vs. caring—The relative impact of sharing decisions versus managing emotions on patient outcomes

Sharing vs. caring—The relative impact of sharing decisions versus managing emotions on patient outcomes

Psychiatric morbidity and its recognition by doctors in patients with cancer

Have we been guilty of ageism in the primary treatment of breast cancer?

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