The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence
- 694 Downloads
Doctor–patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions.
A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013–2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women’s perceived risk of distant recurrence (0–100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295).
About 33% of women reported that doctors discussed risk of recurrence as “quite a bit” or “a lot,” while 14% said “not at all.” Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31–0.81) or those who perceived zero risk (OR .46, CI 0.29–0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry.
Effective doctor–patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians’ ability to engage in individualized communication around risk are needed.
KeywordsBreast cancer Physician communication Risk perception Worry about recurrence
We acknowledge the work of our project staff (Mackenzie Crawford, M.P.H. and Kiyana Perrino, M.P.H. from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, B.A. and Renee Bickerstaff-Magee from USC; Rebecca Morrison, M.P.H., Alexandra Jeanpierre, M.P.H., Stefanie Goodell, B.S., and Rose Juhasz, Ph.D. from the University of Michigan). We acknowledge with gratitude the breast cancer patients who responded to our survey.
This study was funded by Grant P01 CA163233 to the University of Michigan from the National Cancer Institute. The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the CDC or their contractors and subcontractors is not intended nor should be inferred. The collection of cancer incidence data in Georgia was supported by contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the States of California and Georgia, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.
Compliance with ethical standards
Conflicts of interest
Allison Kurian has received research funding for work performed outside of the current study from MyriadGenetics, Invitae, Ambry Genetics, GenDx, and Genomic Health. No other authors have conflicts of interests to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study through their return of a completed survey.
- 5.Lee-Jones C, Humphris G, Dixon R, Hatcher MB (1997) Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psycho-Oncology 6(2):95–105. doi: 10.1002/(sici)1099-1611(199706)6:2<95:aid-pon250>3.0.co;2-b CrossRefPubMedGoogle Scholar
- 21.Rosenberg SM, Tracy MS, Meyer ME, Sepucha K, Gelber S, Hirshfield-Bartek J, Troyan S, Morrow M, Schapira L, Come SE, Winer EP, Partridge AH (2013) Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med 159(6):373–381. doi: 10.7326/0003-4819-159-6-201309170-00003 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Halbach SM, Ernstmann N, Kowalski C, Pfaff H, Pfortner TK, Wesselmann S, Enders A (2016) Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment. Patient Educ Couns 99(9):1511–1518. doi: 10.1016/j.pec.2016.06.028 CrossRefPubMedGoogle Scholar
- 24.Hamstra DA, Johnson SB, Daignault S, Zikmund-Fisher BJ, Taylor JM, Larkin K, Wood A, Fagerlin A (2015) The impact of numeracy on verbatim knowledge of the longitudinal risk for prostate cancer recurrence following radiation therapy. Med Decis Mak 35(1):27–36. doi: 10.1177/0272989x14551639 CrossRefGoogle Scholar
- 28.Partridge A, Adloff K, Blood E, Dees EC, Kaelin C, Golshan M, Ligibel J, de Moor JS, Weeks J, Emmons K, Winer E (2008) Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst 100(4):243–251. doi: 10.1093/jnci/djn010 CrossRefPubMedGoogle Scholar
- 29.Hamilton AS, Hofer TP, Hawley ST, Morrell D, Leventhal M, Deapen D, Salem B, Katz SJ (2009) Latinas and breast cancer outcomes: population-based sampling, ethnic identity, and acculturation assessment. Cancer Epidem Biomark Prev 18(7):2022–2029. doi: 10.1158/1055-9965.epi-09-0238 CrossRefGoogle Scholar
- 30.Dillman D, Smyth J, Christian L (2009) Internet, mail, and mixed-mode surveys: the tailored design method, 3rd edn. Wiley, HobokenGoogle Scholar
- 31.Jagsi R, Griffith KA, Kurian AW, Morrow M, Hamilton AS, Graff JJ, Katz SJ, Hawley ST (2015) Concerns about cancer risk and experiences with genetic testing in a diverse population of patients with breast cancer. J Clin Oncol 33(14):1584–1591. doi: 10.1200/jco.2014.58.5885 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Hawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ (2009) Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst 101(19):1337–1347. doi: 10.1093/jnci/djp271 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Perez EA, Olson JA Jr, Zujewski J, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin P, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Atkins JN, Berenberg JL, Sledge GW (2015) Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med 373(21):2005–2014. doi: 10.1056/NEJMoa1510764 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Vaz-Luis I, Ottesen RA, Hughes ME, Mamet R, Burstein HJ, Edge SB, Gonzalez-Angulo AM, Moy B, Rugo HS, Theriault RL, Weeks JC, Winer EP, Lin NU (2014) Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study. J Clin Oncol 32(20):2142–2150. doi: 10.1200/jco.2013.53.1608 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, Vanryn M (2008) Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 23(5):561–566. doi: 10.1007/s11606-008-0520-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PK, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S (2013) Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 13(Suppl 2):S7. doi: 10.1186/1472-6947-13-s2-s7 CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Engelhardt EG, Pieterse AH, van Duijn-Bakker N, Kroep JR, de Haes HC, Smets EM, Stiggelbout AM (2015) Breast cancer specialists’ views on and use of risk prediction models in clinical practice: a mixed methods approach. Acta Oncol 54(3):361–367. doi: 10.3109/0284186x.2014.964810 CrossRefPubMedGoogle Scholar