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Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study

  • Epidemiology
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Abstract

Patients are increasingly involved in cancer treatment decisions and yet little research has explored factors that may affect patient attitudes and beliefs about their therapeutic choices. This paper examines psychosocial factors (e.g., attitudes, social support), provider-related factors (e.g., communication, trust), and treatment considerations in a prospective study of a sample of non-metastatic breast cancer patients eligible for chemotherapy and/or hormonal therapy (BQUAL cohort). The data come from a multisite cohort study of white, black, Hispanic, and Asian non-metastatic breast cancer patients recruited in New York City, Northern California, and Detroit, Michigan. Baseline surveys were conducted over the telephone between 2006 and 2010 among a total of 1,145 women. Most participants were white (69 %), had more than a high school education (76 %), and were diagnosed with stage I disease (51 %). The majority of women reported discussing chemotherapy and hormonal therapy with their doctor (90 and 83 %, respectively); these discussions primarily took place with medical oncologists. Nearly a quarter of women reported that the treatment decision was difficult, and the majority were accompanied to the doctor (76 %) and involved a friend or family member in making the decision (54 %). Positive considerations (e.g., beliefs about treatment reducing risk of recurrence) were important in making treatment decisions. Participants preferred a shared decision-making style, but results suggested that there is room for improvement in terms of actual patient's involvement in making the decision and provider communication, particularly among black patients. Patients 65 years and older reported fewer provider discussions of chemotherapy, poorer patient–provider communication, higher rates of being assisted by family members in making the decision, and more negative attitudes and beliefs toward treatment.

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Acknowledgments

This study was supported by the awards from the Department of Defense Breast Cancer Center of Excellence (BC 043120) to Dr. Neugut; the National Cancer Institute R01 (CA105274) to Dr. Kushi; the Department of Defense Center for Biobehavioral Breast Cancer Research (DAMD-17-01-1-0334) to Dr. Bovbjerg; the National Cancer Institute R01 (CA100598) to Dr. Ambrosone; and the National Cancer Institute R01 (CA124924 and 127617),U10 (CA 84131), and K05 (CA96940) to Dr. Mandelblatt. Dr. Shelton is supported by a K12 award from the National Center for Advancing Translational Sciences through Columbia University (8 KL2 TR000081-07)..

Ethical Standards

The research presented here complies with the current laws of the United States where the study was conducted.

Conflict of interest

The authors declare they have no conflicts of interest which may have influenced the results of this study.

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Authors and Affiliations

  1. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Rachel C. Shelton

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Grace Clarke Hillyer, Dawn L. Hershman & Alfred I. Neugut

  3. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Dawn L. Hershman & Alfred I. Neugut

  4. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Dawn L. Hershman & Alfred I. Neugut

  5. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Nicole Leoce

  6. Division of Research, Kaiser-Permanente of Northern California, Oakland, CA, USA

    Lawrence H. Kushi

  7. Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA

    Lois Lamerato

  8. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    S. David Nathanson

  9. Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA

    Christine B. Ambrosone

  10. Departments of Psychiatry, Psychology and Behavioral & Community Health Sciences, University of Pittsburgh and the University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Dana H. Bovbjerg

  11. Department of Oncology and Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA

    Jeanne S. Mandelblatt

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  1. Rachel C. Shelton
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  2. Grace Clarke Hillyer
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  3. Dawn L. Hershman
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Correspondence to Rachel C. Shelton.

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Shelton, R.C., Hillyer, G.C., Hershman, D.L. et al. Interpersonal influences and attitudes about adjuvant therapy treatment decisions among non-metastatic breast cancer patients: an examination of differences by age and race/ethnicity in the BQUAL study. Breast Cancer Res Treat 137, 817–828 (2013). https://doi.org/10.1007/s10549-012-2370-4

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