Perceptions of the Risks and Benefits of Adjuvant Breast Radiotherapy: The Influence of Provider Specialty

Abstract

Quite commonly, a physician other than a radiation oncologist first informs a patient about radiotherapy (RT) for breast cancer. Patients’ understanding of radiation therapy after these discussions has not been characterized. We aimed to analyze the association between women’s perceptions of the risks and benefits of radiotherapy and the type of provider consulted. Women with primary invasive, non-metastatic breast cancer or ductal carcinoma in situ were recruited from hospitals in or around Washington, DC and Detroit, MI between July 2006 and April 2011. Psychosocial and healthcare-related data were collected via telephone survey at the time of diagnosis. Specifically, patients were asked about the extent to which the patient’s medical oncologist or surgeon explained the risks and benefits of radiotherapy in Likert-style questions. Clinical data were extracted via chart review upon completion of treatment. Using an ordered logit model, we analyzed the association between multiple demographic, psychosocial, and healthcare-related variables and patients’ perspectives and understanding of the information they received about RT from their surgeons or medical oncologists. Of the 343 consented women, our analytic sample was comprised of 205 women who were eligible for RT after breast conserving surgery or mastectomy (defined as pT3 or N1 or higher after mastectomy). All had spoken to either a surgeon or medical oncologist about further treatment options (chemotherapy, hormone therapy, and radiation), but some may not have spoken to a radiation oncologist. Average age among these women was 55.1 years, 60% self-reported as black, 75% had stage I or II disease, and 70% had a lumpectomy. Multivariate analysis showed that women who saw either a surgeon or a medical oncologist equally believed in the benefits of RT. However, women who saw a medical oncologist for therapy options reported a better understanding of the risks of RT compared to women who primarily had these discussions with their surgeon (OR 1.45, p<0.01). Within the subset of patients who did not report seeing a radiation oncologist (n=81), there were no reported differences in how their surgeons or medical oncologists explained the risks and benefits of RT. Our analysis suggests that a patient’s initial understanding of the risks and benefits of RT may be related to who they receive their information from, which may influence their decision to receive RT. In our study, patients who received their explanations about RT from a medical oncologist had a better understanding of the risks of RT when compared to women who had these discussions with their surgeon. Further studies are needed to characterize the effect of communication between patients and their surgeons and/or medical oncologists on their decision to receive RT and the aspects of RT that require more nuanced explanations to ensure enhanced patient understanding.