The influence of non-clinical patient factors on medical oncologists’ decisions to recommend breast cancer adjuvant chemotherapy
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The extent to which medical oncologists consider non-clinical patient factors when deciding to recommend adjuvant chemotherapy is unknown. Medical oncologists who treated a population-based sample of early stage breast cancer patients reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries 2005–2007 were asked how strongly they consider a patient’s ability to follow instructions, level of social support, and level of work support/flexibility in decisions to recommend adjuvant chemotherapy. Responses of 4 (Quite strongly) or 5 (Very strongly) on a five-point Likert scale defined strong consideration. Associations between oncologist/practice characteristics and strong consideration of each non-clinical factor were examined. 134 oncologists (66 %) reported strong consideration of one or more factor. Ability to follow instructions was strongly considered by 120 oncologists (59 %), social support by 78 (38 %), and work support/flexibility by 73 (36 %). Larger percent of practice devoted to breast cancer was associated with lower likelihood of strongly considering ability to follow instructions [odds ratio (OR) 0.98, 95 % confidence interval (CI) 0.97–0.99; P = 0.04]. Increased years in practice was associated with lower likelihood of strongly considering social support (OR 0.96, CI 0.93–0.99; P = 0.011), while non-white race (OR 2.1, CI 1.03–4.26; P = 0.041) and tumor board access (OR 2.04, CI 1.01–4.12; P = 0.048) were associated with higher likelihood. Non-white race was associated with strongly considering work support/flexibility (OR 2.44, CI 1.21–4.92; P = 0.013). Tumor board access (OR 2, CI 1.00–4.02; P = 0.051) was borderline significant. Non-clinical patient factors play a role in medical oncologist decision-making for breast cancer adjuvant chemotherapy recommendations.
KeywordsDecision making Breast cancer Chemotherapy Social environment Socioeconomic factors
This study was funded by Grants R01 CA109696 and R01 CA088370 from the National Cancer Institute (NCI) to the University of Michigan. Dr. Katz is supported by an Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the NCI (K05CA111340). Dr. Li is supported by an Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the NCI (K05CA111340-01A1 Supplement, PI: Steven Katz). The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code §103885. The NCI’s Surveillance, Epidemiology, and End Results (SEER) Program under contract N01-PC-35139 was awarded to the University of Southern California. Contract N01-PC-54404 and agreement 1U58DP00807-01 were awarded to the Public Health Institute. The collection of metropolitan Detroit cancer incidence data was supported by the NCI’s SEER Program under contract N01-PC-35145.
The authors thank our project staff: Barbara Salem, Paul Abrahamse, and Ashley Gay (University of Michigan); Ain Boone, Cathey Boyer, and Deborah Wilson (Wayne State University) and Alma Acosta, Mary Lo, Norma Caldera, Marlene Caldera, Maria Isabel Gaeta, and Meryl Leventhal (University of Southern California). We also thank the American College of Surgeons Commission on Cancer for their support of this project.
Conflict of interest
The authors declare that they have no conflict of interest.
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