Abstract PD5-06: Impact of an online ductal carcinoma in situ (DCIS) decision support tool on awareness of treatment options and knowledge of breast cancer risks

Abstract

Abstract Background An interactive decision support tool (DST) was adapted to support patients diagnosed with DCIS who are making treatment decisions. The DST provides the following risk estimates over 10 years: 1) future DCIS or invasive breast cancer in the same breast, 2) the risk of dying from causes other than breast cancer, and 3) the risk of dying from invasive breast cancer. Estimates are personalized based on patient age and DCIS grade (low/intermediate versus high grade or “don’t know”) and were based on a model incorporating data from clinical trials and life tables. Methods The DST was implemented in collaboration with the COMET study on the website DCISoptions.org (www.dcisoptions.org). On the DST, personalized results are displayed separately using a 100-woman icon array and percentages with each outcome (future DCIS/invasive breast cancer, death due to breast cancer, death due to other causes) in a different color for each treatment selected by the patient (lumpectomy only, lumpectomy + radiation therapy, lumpectomy + endocrine therapy, lumpectomy + radiation and endocrine therapy, mastectomy with or without reconstruction, bilateral mastectomy with or without reconstruction). In addition, information regarding active monitoring was provided in descriptive terms without icon array display of personalized outcomes. DST users were defined as those who navigated to the website and entered age and DCIS grade allowing them to access the information about expected outcomes. Users were asked to complete an optional survey both prior to use of the DST and after to assess the impact of the DST on: 1) their awareness of options for DCIS treatment, 2) their willingness to consider these options, 3) their knowledge of mortality risks associated with DCIS, and 4) how helpful the DST was to them (after use only). Results As of June 1, 2020, there were 420 users of the DST (total) with 362 completing the pre-tool survey and 58 of whom completed the post-tool survey. Among all DST users, mean age was 54.0 (9.6 years SD) and DCIS was low/intermediate for 72.0%, high for 18.5% and unknown for the remaining 9.5%. Among users who submitted both the pre- and post-tool survey, median time spent on the tool was 10.4 minutes. Awareness of each treatment option was high and did not change with the tool: 90% among both pre-survey and post-survey users except for bilateral mastectomy which remained at 82.9% among pre-survey and post-survey responders. Among those users who completed the pre- and post-tool surveys, the DST increased the percentage of patients who believed the chance of dying from DCIS is very low from 60.3% at baseline to 74.1% (p<0.0001) and reduced the median estimated numerical risk of dying from DCIS in 10 years from 9.0% at baseline to 3.0% (p<0.0001). A large majority of DST users found the tool very helpful or helpful (79.3% of those who responded) in making a treatment decision for DCIS. Discussion DCIS patients have been shown to greatly overestimate the risks of dying from breast cancer and this has been associated with increased anxiety and potential overtreatment. Our personalized online DST significantly improved knowledge about DCIS risks. Future studies of the DST should assess patient characteristics associated with knowledge gains and whether improved knowledge translates to improved patient outcomes including more patient preference and values-based treatment decisions. Citation Format: Rinaa Sujata Punglia, Ann Partridge, Shelley Hwang, Alastair Thompson, Elizabeth Frank, Donna Pinto, Deborah Collyar, Desiree Basila, Thomas Lynch, Terry Hyslop, Marc Ryser, Elissa Ozanne. Impact of an online ductal carcinoma in situ (DCIS) decision support tool on awareness of treatment options and knowledge of breast cancer risks [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD5-06.