Attitudes and Perceptions Towards Radiation Therapy in Breast Cancer Patients: The Role of a Multidisciplinary Care Team

Abstract

Some women considering adjuvant breast radiotherapy (RT) may hold misplaced beliefs about RT, possibly discouraging its use and compromising outcomes. Previous studies have shown that women’s beliefs regarding RT are influenced by a combination of demographic, socioeconomic, cultural, and healthcare-related factors. The role of a multidisciplinary care team in the development of these attitudes, however, remains understudied. We aimed to explore the role of the number and discipline of providers discussing RT with women undergoing treatment for breast cancer in their views on RT’s efficacy. Women with primary invasive, non-metastatic breast cancer were recruited from hospitals in or around Washington, DC and Detroit, MI from 2006 to 2011. Patients were asked about their discussions of adjuvant RT with multiple disciplines, including radiation oncology, surgery, medical oncology, a combination of these specialties, or another specialty. The primary outcome was the probability of agreeing “very much” with the statement “Women are less likely to have the cancer come back if you have radiation therapy.” We used multivariate logit models to clarify the relationship between the number and discipline of providers who discussed RT with these patients and their responses to this statement. These findings were adjusted for demographic and clinical factors including age, race, marital status, clinical stage, hormone receptor status, surgery type, node positivity, chemotherapy utilization, and comorbid disease. Our sample included 185 women who received breast conserving surgery for primary, non-metastatic invasive breast cancer or ductal carcinoma in situ. These women averaged 56 years in age, with the majority (80%) having stage I or II disease. Results from multivariable logit analyses suggests that compared to women who discussed RT with only one oncologist (medical, radiation, or surgical), women who discussed RT with all three oncologists were more likely to report increased agreement with “Women are less likely to have the cancer come back if you have radiation therapy” (OR=2.36, p<0.01). In comparison to women who discussed RT with all three oncologists, women who discussed RT with only a radiation oncologist were less likely to “very much” agree that RT can reduce cancer recurrence (OR=0.28, p<0.01). Overall, women’s beliefs about the efficacy of RT were not dependent on the discipline of oncologist with whom the patient had the RT-related discussion. Involving multiple disciplines in the discussion of adjuvant RT enhances women’s views on its potential benefits. RT was viewed most favorably among women discussing therapy with all three of their oncological providers. In order to improve women’s understanding of the risks and benefits of RT, further examination of physician-related factors is merited.