Medical oncologists and quality of life of women treated for breast cancer.

Abstract

6051 Background: Quality of life (QOL) of breast cancer patients receiving chemotherapy varies widely. More information is needed as to how the organization of care influences the experience of breast cancer patients. We examined the extent to which medical oncologists (oncs) influence breast cancer patient QOL near the time of chemotherapy. Methods: 3133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 in Detroit and Los Angeles were identified through SEER registries and surveyed after diagnosis (n = 2268, response rate 72.4%). For women who received systemic chemotherapy (n = 1,116), treating oncs were identified and surveyed (n = 207, RR 65%). Patient survey, SEER and onc data were then merged (480 patients and 145 oncs). The 5 subscales of the FACT-B – social well being (SWB), functional (FWB), physical (PWB), emotional (EWB), and breast cancer specific (BCS) - were dependent variables. Independent variables included patients factors (demographics, stage, surgery type, chemotherapy status (completed vs. ongoing), comorbidities) and onc factors (practice size, use of support personnel, university affiliation, weekly patient care hours, breast cancer case volume, frequency of visits during chemotherapy, and education/support resources). We compared the mean FACT-B scores across oncs. For each FACT-B subscale, we used random effects models to evaluate the variation at the onc level, sequentially controlling for patient and onc factors. Results: The mean (SD) FACT-B score for the sample was 95.1 (1.0) (best possible score = 144), with a range across 145 oncs between 44 and 135. The variation in FACT-B scores explained by onc characteristics was modest (7.9%). Similar effects were found for SWB (9.3%), FWB (8.2%), and BCS (7.2%). The variation explained by oncs for EWB (6.6%) and PWB (3.2%) was weaker. No specific onc variables were significantly associated with the FACT-B or subscales. Conclusions: There is modest variation in QOL among breast cancer patients receiving chemotherapy that is attributable to oncs. Oncs contribute most to SWB and FWB. Further understanding of the mechanisms by which oncology practices improve patient QOL is warranted. No significant financial relationships to disclose.