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Breast Cancer Surgery Decision Role Perceptions and Choice of Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Retrospective studies have reported that breast cancer patients who perceived more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. We examined this in a prospective study.

Methods

100 newly diagnosed breast cancer patients identified their decision- making role using the Patient Preference Scale. Chart review captured the initial surgery received. Patient decision role preference, role perception, role concordance, and provider role perception were compared with type of surgery to assess differences between mastectomy and lumpectomy groups and unilateral versus bilateral mastectomy. We compared type of surgery and patient role concordance. Satisfaction with Decision immediately after the visit, Decision Regret and FACT-B quality of life at 2 weeks and 6 months were assessed and compared with type of surgery.

Results

Patient decision role preference (p = 0.49) and perception (p = 0.16) were not associated with type of surgery. Provider perception of patient role was associated with type of surgery, with providers perceiving more passive patient roles in the mastectomy group (p = 0.026). Patient role preference varied significantly by stage of disease (= 0.024), with stage 0 (64%, N = 6) and stage III (60%, N = 6) patients preferring active roles and stage I (60%, N = 25) and stage II (52%, N = 16) patients preferring a collaborative role.

Conclusions

Patient role preference and perception were not associated with type of surgery, while provider perception of patient role was. Patient role preference varied by stage of disease. Further study is warranted to better understand how disease factors and provider interactions affect decision role preferences and perceptions and surgical choice.

Trial Registration

The study was registered with clinicaltrials.gov (NCT03350854). https://clinicaltrials.gov/ct2/show/NCT03350854.

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Acknowledgment

This work was supported by the Building Interdisciplinary Research Careers in Women’s Health Program of the National Institutes of Health under Award Number K12HD085852 and the Agency for Healthcare Research and Quality Award Number R03HS024784. This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR00253.

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Authors and Affiliations

  1. Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Lily Gutnik MD, MPH & Cindy B. Matsen MD, MSCI, FACS

  2. Division of Epidemiology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA

    Chelsea McCarty Allen PhD & Angela P. Presson PhD

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  1. Lily Gutnik MD, MPH
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  2. Chelsea McCarty Allen PhD
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  4. Cindy B. Matsen MD, MSCI, FACS
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Correspondence to Cindy B. Matsen MD, MSCI, FACS.

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Gutnik, L., Allen, C.M., Presson, A.P. et al. Breast Cancer Surgery Decision Role Perceptions and Choice of Surgery. Ann Surg Oncol 27, 3623–3632 (2020). https://doi.org/10.1245/s10434-020-08485-8

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