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Patient preferences for locoregional therapy in early-stage breast cancer

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Abstract

Purpose

With an increasing emphasis on patient-centered care, clinicians in subspecialties such as breast surgery and radiation oncology that offer multiple therapeutic options with equivalent outcomes are under increasing pressure to aid patients with the decision-making process. The aim of this review is to summarize existing studies that either evaluated factors in patient’s decision-making regarding locoregional therapy in early-stage breast cancer or evaluated benefit thresholds required to change therapy decisions.

Methods

A PubMed search to identify prospective or retrospective studies written in English reporting factors in patient decision-making regarding locoregional therapy in early-stage breast cancer was conducted. No restriction was placed on publication date. Studies that focused on breast reconstruction decisions or on patient preferences for decision-making involvement were excluded.

Results

A total of 39 studies were identified; 19 examining patient preferences for breast-conserving surgery versus mastectomy, 7 on preferences for contralateral prophylactic mastectomy, 2 on non-surgical options, 2 on the extent of axillary surgery, and 9 on radiation therapy decisions. Themes such as fear of recurrence, desire to avoid additional invasive therapy, and the importance of physician preference were common, but many studies also highlighted factors important to specific subpopulations of women.

Conclusions

Patient preference is difficult to define and measure, and heterogeneity across studies renders direct comparison difficult. Future work is needed to define women’s risk-thresholds for certain treatments, delve into the psychological factors that direct their decisions, and understand how patients’ valuations of risk interact with society’s.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, 450 Brookline Ave, Yawkey 12, Boston, MA, 02215, USA

    Christina A. Minami, Tari A. King & Elizabeth A. Mittendorf

  2. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Christina A. Minami, Tari A. King & Elizabeth A. Mittendorf

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  1. Christina A. Minami
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  2. Tari A. King
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  3. Elizabeth A. Mittendorf
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Correspondence to Elizabeth A. Mittendorf.

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CAM reports no disclosures. TAK has received speaker fees from Genomic Health. EAM reports receiving honoraria from Physician Education Resource; paid compensation for participation on Scientific Advisory Boards for Genomic Health, Merck, Paregrine Pharmaceuticals, Sella Life Science, and Tapimmune; and research funding from Glaxo SmithKline. Her institution has received research funding from Astra Zeneca, EMD Serono, Galena Biopharma and Genentech/Roche.

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Minami, C.A., King, T.A. & Mittendorf, E.A. Patient preferences for locoregional therapy in early-stage breast cancer. Breast Cancer Res Treat 183, 291–309 (2020). https://doi.org/10.1007/s10549-020-05737-9

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