Surgeon specialization and patient satisfaction with breast cancer treatment

Abstract

11012 Background: Experience and practice setting vary greatly among surgeons who treat patients with breast cancer. Yet, little is known about how these factors influence patient outcomes such as patient satisfaction with aspects of care. Methods: All women with DCIS and a 20% random sample of women with invasive breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles metropolitan SEER registries were identified and surveyed shortly after receipt of surgical treatment. Attending surgeons were identified primarily using pathology reports and mailed a survey. The final sample contained complete dyad information for 64.6% of patients (n=1,539) and 69.7% of surgeons (n=318). Logistic regression was used to examine the associations between surgeon specialization (% of practice devoted to breast disease) and treating hospital cancer program status (no program, American College of Surgeons approved cancer program, or NCI cancer center) with four domains of patient satisfaction: 1) the surgical decision, 2) decision-making process, 3) surgeon-patient relationship, and 4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage. Results: 34.5%, 32.5% and 33.0% of patients were treated by surgeons who devoted <30% (low volume), 30%-60% (medium volume), and >60% (high volume) of their practice to breast disease. Compared to patients who were treated by low volume surgeons, patients treated by medium or high volume surgeons were more satisfied with the decision making process (medium volume: OR=1.2, 95%CI 0.8–1.7, high volume: OR=1.8, 95% CI 1.1- 2.8, p=0.036) and more satisfied with the surgeon-patient relationship (medium volume: OR=1.1, 95% CI 0.7 - 1.7, high volume: OR=2.1, 95% CI 1.1–3.7, p=0.053). Similar trends were observed for the other domains of satisfaction. Treatment setting was not associated with patient satisfaction after controlling for other factors. Conclusions: Surgeon specialization, but not treatment setting, was associated with patient satisfaction. Examining the processes underlying these associations could inform strategies to improve the quality of breast cancer care. No significant financial relationships to disclose.