Recurrence risk perception and quality of life following treatment of breast cancer

Abstract

Purpose Little is known about different ways of assessing risk of distant recurrence following cancer treatment (e.g., numeric or descriptive). We sought to evaluate the association between overestimation of risk of distant recurrence of breast cancer and key patient reported outcomes, including quality of life and worry. Methods We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer identified through SEER registries of Los Angeles & Georgia (2013-14) ∼2 months after surgery (N=2578, RR=71%). Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low risk invasive cancer (Stg 1A, ER+HER2-, Gr 1-2). Women reported perceptions of their risk numerically (0 – 100%), with values ≥10% for DCIS & ≥20% for invasive considered overestimates. Perceptions of “moderate, high or very high” risk were considered descriptive overestimates. In our analytic sample (N=927), we assessed factors correlated with both types of overestimation and report multivariable associations between overestimation and QoL (PROMIS physical & mental health) and frequent worry. Results 30.4% of women substantially overestimated their risk of distant recurrence numerically and 14.7% descriptively. Few factors other than family history were significantly associated with either type of overestimation. Both types of overestimation were significantly associated with frequent worry, and lower QoL. Conclusions Ensuring understanding of systemic recurrence risk, particularly among patients with favorable prognosis, is important. Better risk communication by clinicians may translate to better risk comprehension among patients and to improvements in QoL.

Disparities in risk perception of thyroid cancer recurrence and death

“…However, to the best of our knowledge, there is a lack of data regarding the relationship between risk estimation and worry in survivors of thyroid cancer. Consistent with studies in the breast cancer literature, we found that patients who overestimated their risks of recurrence and mortality were more likely to report cancer‐related worry . In addition, Papaleontiou et al demonstrated that in a cohort of patients with DTC, a lower educational level was associated with more worry about recurrence and death from thyroid cancer, and Hispanic patients were more worried about death compared with their white counterparts 2 to 4 years after diagnosis .…”

“…Consistent with studies in the breast cancer literature, we found that patients who overestimated their risks of recurrence and mortality were more likely to report cancer-related worry. 19,29,30 In addition, Papaleontiou et al demonstrated that in a cohort of patients with DTC, a lower educational level was associated with more worry about recurrence and death from thyroid cancer, and Hispanic patients were more worried about death compared with their white counterparts 2 to 4 years after diagnosis. 5 Despite the observed crosssectional association between recurrence and mortality risk overestimation and cancer-related worry, with both more likely to occur among less educated and/or Hispanic patients, to our knowledge the causality between these 2 variables remains unknown.…”

“…For the analysis, we converted responses into percentages (11‐point scale: increments of 10% and endpoints of ≤5% and ≥95%). Using categories similar to those in breast cancer studies conducted by members of our team to assess risk estimation, we categorized the outcomes into 2 groups: reasonably accurate estimate (risk perception of ≤5% or 10%) versus overestimation (risk perception of 20% to ≥95%) of disease recurrence and mortality risk in this analytic sample of patients with clinically determined 10‐year recurrence and mortality risks of ≤5% …”

Retracted: Development and validation of algorithms to differentiate ductal carcinoma in situ from invasive breast cancer within administrative claims data

“…DCIS has been recognized as a potential source of overtreatment because, to our knowledge, it currently is unknown how to determine whether it will progress to invasive disease . Women also are concerned about disease recurrence, which has been linked to worry and a lower quality of life for patients with breast cancer . DCIS represents approximately 20% of breast cancers that are identified through mammography screening .…”

The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population‐based sample of breast cancer patients

“…The importance of these values, which have been identified in prior studies, reinforces the need to address directly patients' perceptions of the risk of recurrence and their reactions to it because many patients overestimate the actual risk of recurrence after treatment. Furthermore, prior work by our team has shown an association between worry about recurrence and subsequent receipt of CPM .…”