According to the findings of a new study done by researchers at the University of North Carolina less than half the breast cancer survivors surveyed in the study were ever asked about their personal preference for surgery prior to beginning treatment.
According to the findings of a new study done by researchers at the University of North Carolina less than half the breast cancer survivors surveyed in the study were ever asked about their personal preference for surgery prior to beginning treatment. Their surgeons did not explain to them that they had surgical options. They could have either a full mastectomy or breast-conserving lumpectomy.
“We found that breast cancer survivors had fairly major gaps in their knowledge about their surgical options, including the implications for recurrence and survival,” said study lead author Dr. Clara Lee, an associate professor of surgery and director of surgical research at the University of North Carolina School of Medicine in Chapel Hill.
Dr. Lee and her colleagues sent surveys to 746 women who had undergone surgery for stage one or stage two breast cancer at one of four medical centers: the Dana-Farber Cancer Institute and the Massachusetts General Hospital in Boston; the University of California, San Francisco; and the University of North Carolina, Chapel Hill.
Of the 440 respondents, less than half (about 46 percent) knew that local recurrence risk is higher after breast-conserving surgery (lumpectomy) than after mastectomy, and only about 56 percent of women knew that survival rates are equivalent for both surgical options.
Other information that came to light in the study revealed that women who said they preferred mastectomy were less likely to have treatment that was in accordance with their goals. Lee said this was probably because patients reported that their doctors were more likely to discuss breast conservation therapy and its advantages than mastectomy.
Many women did not remember being asked for their preference between the surgical options available to them.
The fact that less than half (48.6 percent) of the patients recalled being asked their preference was particularly concerning to Lee.”It would be one thing if we were talking about decisions for which there is clearly a superior treatment, such as treatment for an inflamed gallbladder,” Lee said. “In this case, it’s reasonable and actually better for the surgeon to make a recommendation. But here we’re talking about a decision where there is no medically right answer, and it really depends on the patient’s preference. In that situation, it makes sense to ask the patient what she prefers.”
Another breast cancer surgeon cautioned that the retrospective nature of the study (asking women to recall past events) “Clearly there are deficits in knowledge, but what we don’t know for sure is if that’s because the surgeon failed to convey this information, or the surgeon failed to convey it in a way that the patient could understand, or the patient has simply forgotten,” said Dr. Leslie Montgomery, chief of breast surgery at Montefiore Medical Center in New York City.
“If anything, I’m actually surprised that the numbers were as good as they were,” Montgomery added. “There’s often a big difference between what a woman is told and what she actually absorbs at a time when she is so emotionally distressed.”
“As surgeons, we really need to make sure we convey the proper information to a woman at what is probably one of the most stressful times in her life,” Montgomery said.
SOURCE: January 2012, Journal of the American College of Surgeons
