Recurrence risk perception and quality of life following treatment of breast cancer
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Little is known about different ways of assessing risk of distant recurrence following cancer treatment (e.g., numeric or descriptive). We sought to evaluate the association between overestimation of risk of distant recurrence of breast cancer and key patient-reported outcomes, including quality of life and worry.
We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer identified through SEER registries of Los Angeles County & Georgia (2013–14) ~2 months after surgery (N = 2578, RR = 71%). Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low-risk invasive cancer (Stg 1A, ER+, HER2−, Gr 1–2). Women reported perceptions of their risk numerically (0–100%), with values ≥10% for DCIS & ≥20% for invasive considered overestimates. Perceptions of “moderate, high or very high” risk were considered descriptive overestimates. In our analytic sample (N = 927), we assessed factors correlated with both types of overestimation and report multivariable associations between overestimation and QoL (PROMIS physical & mental health) and frequent worry.
30.4% of women substantially overestimated their risk of distant recurrence numerically and 14.7% descriptively. Few factors other than family history were significantly associated with either type of overestimation. Both types of overestimation were significantly associated with frequent worry, and lower QoL.
Ensuring understanding of systemic recurrence risk, particularly among patients with favorable prognosis, is important. Better risk communication by clinicians may translate to better risk comprehension among patients and to improvements in QoL.
KeywordsBreast cancer Risk Perception Quality of life
This work 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 103 885; 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. We acknowledge the outstanding 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., Rachel Tocco, M.A., 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.
Compliance with ethical standards
Conflict of interest
Dr. Kurian has received research funding for work performed outside of the present study from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health. All the other authors have no conflict to disclose.
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.
- 2.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
- 3.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
- 6.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
- 9.Fisher CS, Martin-Dunlap T, Ruppel MB, Gao F, Atkins J, Margenthaler JA (2012) Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. Ann Surg Oncol 19(10):3246–3250. doi: 10.1245/s10434-012-2525-x CrossRefPubMedGoogle Scholar
- 12.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 Epidemiol Biomark Prevent 18(7):2022–2029. doi: 10.1158/1055-9965.epi-09-0238 CrossRefGoogle Scholar
- 13.Dillman D, Smyth J, Christian L (2009) Internet, mail, and mixed-mode surveys: the tailored design method, 3rd edn. Wiley, HobokenGoogle Scholar
- 14.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
- 17.PROMIS Patient-Reported Outcomes Measurement Information System: dynamic tools to measure health outcomes from the patient perspective. http://www.nihpromis.org. Accessed 24 June 2016
- 18.Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA, Hawkins NA, Rowland JH (2012) Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev 21(11):2108–2117. doi: 10.1158/1055-9965.epi-12-0740 CrossRefGoogle Scholar
- 19.Raghunathan TE, Lepkowski JM, Van Hoewyk J, Solenberger P (2001) A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodol 27(1):85–96Google Scholar
- 24.The Joint Commission (2007) What did the doctor say?: Improving health literacy to protect patient safety. The Joint Commission, Oakbrook TerraceGoogle Scholar