Underuse of Breast Cancer Adjuvant Treatment: Patient Knowledge, Beliefs, and Medical Mistrust

Bickell, Nina A.; Weidmann, Jessica; Fei, Kezhen; Lin, Jeng-Wen; Leventhal, Howard

doi:10.1200/jco.2009.22.9773

Cited by 158 publications

(127 citation statements)

References 51 publications

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“…Decisions are often time-intensive, complicated, and nuanced, and effective communication is crucial. 30,31 Moreover, such complex care may be particularly challenging for patients with limited social support, superseding life stressors, or medical comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Breast cancer care has become increasingly complex, with multiple providers and office visits required to complete recommended adjuvant therapy. Patient factors, such as difficulty accessing care even with insurance, 28 mistrust of the medical system, [28][29][30] and differing preferences may be important. 30,31 Disparities in care are also influenced by the characteristics of physicians 32 and hospitals 33 from which patients obtain care.…”

Section: Discussionmentioning

confidence: 99%

“…Patient factors, such as difficulty accessing care even with insurance, 28 mistrust of the medical system, [28][29][30] and differing preferences may be important. 30,31 Disparities in care are also influenced by the characteristics of physicians 32 and hospitals 33 from which patients obtain care. Once breast cancer is diagnosed, patients must navigate through surgical, radiation oncology, and medical oncology visits and must carefully consider adjuvant treatment options.…”

Section: Discussionmentioning

confidence: 99%

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The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Freedman

Virgo

et al. 2010

Cancer

181

146

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BACKGROUND: Few data are available on how race/ethnicity, insurance, and socioeconomic status (SES) interrelate to influence breast cancer treatment. The authors examined care for a national cohort of breast cancer patients to assess whether insurance and SES were associated with racial/ethnic differences in care. METHODS: The authors used multivariate logistic regression to assess the probability of definitive locoregional therapy, hormone receptor testing, and adjuvant systemic therapy among 662,117 white, black, and Hispanic women diagnosed with invasive breast cancer during 1998-2005 at National Cancer Data Base hospitals. In additional models, the authors included insurance and area-level SES to determine whether these variables were associated with observed racial/ethnic disparities. RESULTS: Most women were white (86%), 10% were black, and 4% were Hispanic. Most had private insurance (51%) or Medicare (41%). Among eligible patients, 80.0% (stage I/II) had definitive locoregional therapy, 98.5% (stage I-IV) had hormone receptor testing, and 53.1% and 50.2% (stage I-III) received adjuvant hormonal therapy and chemotherapy, respectively. After adjustment, black (vs white) women had less definitive locoregional therapy (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.88-0.94), hormonal therapy (OR, 0.90; 95% CI, 0.87-0.93), and chemotherapy (OR, 0.87; 95% CI, 0.84-0.91). Hispanic (vs white) women were also less likely to receive hormonal therapy. Hormone receptor testing did not differ by race/ethnicity. Racial disparities persisted despite adjusting for insurance and SES. CONCLUSIONS: The modest association between black (vs white) race and guideline-recommended breast cancer care was insensitive to adjustment for insurance and area-level SES. Further study is required to better understand disparities and to ensure receipt of care. Cancer 2011;117:180-9.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Freedman

Virgo

et al. 2010

Cancer

181

146

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“…As a result of the decision complexity, communication challenges, patients' heightened emotional state, and time pressure to make a decision, many patients unfortunately make decisions without fully understanding the options and associated risks and benefits [27][28][29]. In some cases, this lack of knowledge can lead to an underuse or overuse of cancer treatments [30,31].…”

Section: The Process Of Shared Decision Making In Oncology Practicementioning

confidence: 99%

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

2012

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Learning Objectives After completing this course, the reader will be able to: Outline the five steps that comprise shared decision making. Identify specific tactics that can be used to engage a patient in a shared decision making process. This article is available for continuing medical education credit at http://CME.TheOncologist.com Background. There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference‐sensitive decisions by incorporating patient preferences into decision discussions. Methods. This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient‐centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference‐sensitive decisions in which SDM can enhance the clinical encounter. Results. Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision‐making process. Conclusion. Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.

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“…26,27 For example, studies from European populations have suggested that men of higher education level or from more affluent areas were more likely to seek aggressive treatment for prostate cancer-a behavior that may be driven by trust in providerdelivered therapies and willingness to receive treatment despite potential risks and side effects. 10,28 Schulman et al 29 found that patient race independently influences physician treatment recommendations, with physicians more likely to recommend aggressive therapy for white patients compared with black patients when presented with hypothetical cases of chest pain.…”

Section: Discussionmentioning

confidence: 99%

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

Mahal

Cooperberg

Aizer³

et al. 2015

The American Journal of Medicine

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PURPOSE: The long-term prostate cancer-specific survival for patients initially managed with active surveillance for low-risk prostate cancer ranges from 97% to 100%. We characterized factors that are associated with aggressive treatment with radical prostatectomy or radiation for indolent prostate cancer (defined as screening-detected, low-risk disease). METHODS: The Surveillance, Epidemiology, and End Results Program was used to extract a cohort of 39,803 men diagnosed with prostate-specific antigenedetected, low-risk prostate cancer (clinical category T1c, Gleason score 6, and prostate-specific antigen <10) from 2004 to 2010. After socioeconomic profiles were generated from county-linked education and income data, multivariable logistic regression was used to determine whether there were any factors associated with high rates of aggressive treatment. RESULTS: The rate of aggressive treatment among all men with indolent prostate cancer was 64.3%. Greater rates of aggressive treatment were experienced by men with high socioeconomic status, Caucasian men, and married men (P < .001 for all cases). The increased adjusted odds for receipt of aggressive therapy were 1.25 (95% confidence interval [CI], 1.17-1.32; P < .001), 1.26 (95% CI, 1.21-1.32; P < .001), and 1.88 (95% CI, 1.80-1.97; P < .001) for men with high socioeconomic status, Caucasian men, and married men, respectively, compared with men with low socioeconomic status, non-Caucasian men, and unmarried men, respectively. CONCLUSIONS: Although men with high socioeconomic status, Caucasian men, and married men often receive the highest quality health care and have the best outcomes for many cancers, it seems that they are most at risk for the avoidable potential harms of aggressive treatment of indolent prostate cancer. Future policy should encourage more stringent guidelines for deferred treatment and culturally and sociodemographically competent counseling of active surveillance.

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Underuse of Breast Cancer Adjuvant Treatment: Patient Knowledge, Beliefs, and Medical Mistrust

Cited by 158 publications

References 51 publications

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

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