The patient's perspective on breast radiotherapy: Initial fears and expectations versus reality

Shaverdian, Narek; Wang, Xiaoyan; Hegde, John V.; Aledia, Criselda; Weidhaas, Joanne B.; Steinberg, Michael L.; McCloskey, Susan A.

doi:10.1002/cncr.31159

Cited by 35 publications

(40 citation statements)

References 38 publications

(86 reference statements)

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“…Treatment of early-stage breast cancer can be considered as a preference-sensitive setting, where decision-making between treatment options can change according to patient preferences [7]. Typical factors able to influence the therapeutic choice in favor of mastectomy include: (i) concerns regarding cancer recurrence, (ii) perception that health outweighs breast retention [8], or (iii) perceived consequences of BCT, including potential adverse effects of radiation therapy [7,9]. Moreover, a renewed interest and trend towards mastectomy has recently emerged, with an increased use of skin-sparing or nipple-sparing mastectomies with immediate breast reconstruction [10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini

Reitz

Pazos

et al. 2019

Cancers

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Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.

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Section: Introductionmentioning

confidence: 99%

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini

Reitz

Pazos

et al. 2019

Cancers

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“…The slightly more toxic radiotherapy protocol was the factor with the highest potential to prevent patients from participation in an organ-preservation trial. This observation is likely associated with long known fears and misperceptions of radiotherapy (22). Already in the 1970s a study by Peck et al showed that the majority of patients in reference to radiotherapy “believed that requiring radiotherapy was bad news” and that “radiotherapy is inherently damaging” (23).…”

Section: Discussionmentioning

confidence: 99%

Organ Preservation in Rectal Cancer: The Patients' Perspective

Gani

Gani²,

Zschaeck

et al. 2019

Front. Oncol.

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Organ preservation after a clinical complete response to radiochemotherapy is currently one of the most discussed topics in the management of rectal cancer. However, the patients' perspective has only been poorly studied so far. In this multicenter study, we examined 49 patients with locally advanced rectal cancer. The willingness to participate in an organ preservation study and the acceptance of the associated aspects such as intensified radiochemotherapy protocols, the need for close follow-up examinations and local regrowth rates were assessed. Attitudes were correlated with baseline quality of life parameters and psychological scales for “fear of progression”, “locus of control”, “depression”, and the “willingness to take risks”. A total of 83% of patients would consider the deferral of surgery in case of a clinical complete response (cCR). Three monthly follow-up studies and a 25% local regrowth rate are considered acceptable by 95% and 94% respectively. While 41% would be willing to exchange cure rates for a non-operative treatment strategy, a potentially more toxic radiochemotherapy in order to increase the probability of a cCR was the aspect with the lowest acceptance (55%). Psychological factors, in particular “locus of control” and “willingness to take risks”, influenced patient preferences regarding most of the assessed parameters. While in general a broad acceptance of an organ-preserving treatment can be expected, patient preferences and concerns regarding different aspects of this strategy vary widely and require specific consideration during shared decision making.

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“…The levels of awareness found in this study are consistent with those reported in previous literature. 24-26 RT awareness was influenced by population category, place of residence, age, marital status, level of education, and occupation. As previously reported, 26 awareness was lower in the general public and patients with cancer compared with other categories of the population.…”

Section: Discussionmentioning

confidence: 99%

“…These results are consistent with those reported by Gillan et al, 16 who found that approximately one third of the public had negative perceptions about RT. 16 Shaverdian et al 24 found that negative perceptions were fueled by concerns about side effects, such as skin burns, hair loss, and nausea and vomiting. Perceptions about RT were most negative in the general public and most positive in patients with cancer and medical/nursing students.…”

Section: Discussionmentioning

confidence: 99%

Public Awareness and Perceptions of Radiotherapy and Their Influence on the Use of Radiotherapy in Dar es Salaam, Tanzania

Soko

Burambo

Mngoya

et al. 2019

JGO

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PURPOSE Misconceptions associated with radiotherapy (RT) may affect the patient’s choice to undergo or not undergo RT. In this study, the level of awareness and perceptions about radiation and RT, as well as their impact on the use of RT, were assessed. MATERIALS AND METHODS A cross-sectional survey was conducted in the city of Dar es Salaam, Tanzania, between November 2018 and March 2019. Stratified sampling was used to obtain a sample of 629 participants from 4 strata, including 53 patients with cancer, 129 health professionals, 127 medical and nursing students, and 320 respondents from the general public. A questionnaire with 13 items measuring awareness and 8 items measuring perceptions was used for data collection. The Kruskal-Wallis test and χ2 test were used to test association between predictor and outcome variables. Statistical analyses were performed using statistical software. RESULTS The percentage of right responses was < 50% in all 13 awareness items. Only 16.9% of respondents were aware that RT would not reduce their lifespan. Only 34.5% of respondents had positive perceptions of RT. Awareness was higher among medical/nursing students, younger respondents, single or cohabiting respondents, and those who had attained a college or higher education. Overall, 52% would accept receiving RT if recommended as part of their treatment. Those who would accept undergoing RT were more likely to have higher awareness and a positive perception of RT. CONCLUSION Public awareness of RT in Dar es Salaam is low, and negative perceptions prevail. Low levels of awareness and negative perceptions have a negative effect on the use of RT.

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The patient's perspective on breast radiotherapy: Initial fears and expectations versus reality

Cited by 35 publications

References 38 publications

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Organ Preservation in Rectal Cancer: The Patients' Perspective

Public Awareness and Perceptions of Radiotherapy and Their Influence on the Use of Radiotherapy in Dar es Salaam, Tanzania

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