Women Feel Uniformed About Breast Cancer Treatment

Breast cancer is one of the most common cancers diagnosed among women in the United States and although the disease is common, many patients may feel that the process of choosing the best treatment is overwhelming.

An analysis of 2 studies published by the Journal of the American College of Surgeons suggests that patients who underwent breast cancer surgery feel uninformed about their options, but a web-based tool could help educate patients better than cancer websites.

Patients who used the decision tool were more likely to understand that waiting a few weeks to consider different treatments would not adversely affect survival, according to the study authors.

“We were really interested in providing the patient perspective,” said Sunny Mitchell, MD, lead author of the first study that found a majority of patients felt uninformed about treatment options. “On top of exploring how women become informed about their treatment options, we also wanted to identify any opportunities for improvement.

The first study was a post-treatment survey that was administered to patients recruited from health-related organizations. Included in the study were 487 women aged 18 to 99 years who had breast cancer and underwent a lumpectomy, mastectomy, or both surgeries.

The authors found that 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients who received both surgeries said that making a fast treatment decision was more important than weighing their options.

Regardless of treatment group, a majority of patients agreed somewhat or strongly to the statement that they wished they had more time to explore different surgical options.

When asked about how educated they felt about treatment options before surgery, 47% of lumpectomy-only patients and 67% of mastectomy-only patients said they were completely informed, according to the study. Notably, only 28% of patients who received both operations felt completely informed, according to the study.

The authors said they were surprised to see how many patients did not feel informed before their surgery. To address this gap, the authors suggest that additional studies should explore how to best convey the information through different mediums, including brochures, decision aids, and videos, according to the study.

While many patients do their own research, they likely do not have the necessary tools to develop an optimal treatment plan. This highlights the responsibility of health care providers to ensure that patients receive the information necessary for treatment decisions, according to the authors.

In the second study, the authors explored the efficacy of web-based decision tools versus cancer websites. Patients with stage 0 to 3 breast cancer who were considering an operation were randomized to visit the web-based tool or standard cancer sites.

The authors discovered that the decision aids were more effective in educating patients compared with cancer sites, including breastcancer.org, the American Cancer Society, and the National Cancer Institute.

Patients who consulted the decision tool were more engaged, able to discuss their concerns, and voice their opinions, according to the study.

“In addition to providing information, the decision aid allows patients to compare choices by presenting the information in a parallel way,” said lead author Heather Neuman, MD, MS, FACS. “It includes extra pieces of information that prompt patients to think about their values and preferences.”

Prior to the patient’s first surgical consultation, they received a questionnaire that asked about their knowledge regarding the procedure.

Overall, patients who used the decision aid had a higher level of knowledge compared with patients who visited the standard cancer sites.

Also, 72% of patients using the decision aid understood that waiting to make a decision would not affect survival compared with 54% of patients visiting the standard websites, according to the study.

“Patients come in with this urgency, and this finding tells them they can slow down. They don’t need to have that anxiety,” Dr Neuman said.

Reducing the urgency about cancer treatment decisions may lead to better discussions with their surgeon, which could result in a more optimal treatment strategy, according to the authors.

“This process of sending something by email works, and for a general surgeon in a more rural area, that’s something they could do to improve care,” Dr Neuman concluded.