Influence of nonclinical patient factors on decisions to recommend breast cancer adjuvant chemotherapy.

Abstract

Listen

Translate article

6032 Background: Little is known about the extent nonclinical patient factors are considered by oncologists when deciding to recommend adjuvant breast cancer chemotherapy and whether oncologist and practice characteristics are associated with these attitudes. Methods: Medical oncologists (n = 305) providing care to early-stage breast cancer patients reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries were invited to complete a survey. They were asked to rate how strongly they consider each of the following—a patient's ability to follow instructions, level of social support, and level of support/flexibility at work—when making adjuvant chemotherapy recommendations. For each nonclinical factor, a multivariate logistic regression model was used to investigate associations between oncologist/practice characteristics and response that the nonclinical factor is strongly (4 or 5 on a 5-point Likert scale) considered, controlling for demographics such as sex, race, and academic affiliation. Results: 206 oncologists completed the survey (67.5% response rate). A patient's ability to follow instructions was reported by 58.8% to be strongly considered, social support by 38.0%, and work support/flexibility by 35.8%. In multivariate analyses, devoting a larger percent of practice to breast cancer was associated with lower likelihood that patients' ability to follow instructions was strongly considered (OR 0.98, p = 0.04). Increased years in practice was associated with lower odds that social support was considered (OR 0.97, p = 0.03). Access to tumor board increased the odds that social support (OR 2.04, p = 0.05) and work support/flexibility (OR 2.21, p = 0.03) were considered. No other oncologist or practice characteristics were associated with strong consideration of the 3 nonclinical factors. Conclusions: Medical oncologists frequently report that they consider nonclinical factors in their decision to recommend breast cancer adjuvant chemotherapy. Greater specialization and longer practice experience are associated with less emphasis on nonclinical factors, while access to a tumor board is associated with stronger consideration of these factors. No significant financial relationships to disclose.