TY - JOUR
T1 - Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy
T2 - Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients
AU - Lizarraga, Ingrid M.
AU - Schroeder, Mary C.
AU - Jatoi, Ismail
AU - Sugg, Sonia L.
AU - Trentham-Dietz, Amy
AU - Hoeth, Laurel
AU - Chrischilles, Elizabeth A.
N1 - Funding Information:
The authors thank Julie McGregor, Amy Godecker, Kathy Peck, and Sarah Esmond for assistance with data collection and study conduct; the Share Thoughts on Breast Cancer patient advocates who helped develop the study questionnaire, including Laurel Hoeth, Cheryl Jernigan, and Jody Rock; the study site coordinators and project managers who conducted the study mailings, including Teresa Bosler, Michele Coady, Mack Dressler, Sarah Esmond, Bret Gardner, Amy Godecker, Brian Gryzlak, Julie McGregor, Deb Multerer, Char Napurski, Kathy Peck, Nick Rudzianski, Sabrina Uppal, Xiao Zhang, and Brittany Zschoche; investigators overseeing data collection including Drs. Anne Berger, Anne Blaes, Elizabeth Chrischilles, Lindsay Cowell, Barbara Haley, Jennifer Klemp, Ingrid Lizarraga, Joan Neuner, Adedayo Onitilo, Amalie Ramirez, and Priyanka Sharma; and the Greater Plains Collaborative informatics team who integrated tumor registry data and selected the study samples, including Bhargav Adagarla, Daniel Connolly, Tamara McMahon, Glenn Bushee, Supreet Kathpalia, Jim McClay, Eneida Mendonca, Tom Mish, Susan Morrison, Phillip Reeder, Nicholas Smith, and Laurel Verhagen.
Funding Information:
This project was supported in part by PCORI contract CDRN-1306-04631, along with NIH grants UL1TR002537 for the University of Iowa Institute for Clinical and Translational Science, P30 CA086862 for the Holden Comprehensive Cancer Center (Chrischilles), and P30 CA014520 for the University of Wisconsin Carbone Cancer Center (Trentham-Dietz).
Publisher Copyright:
© 2021, Society of Surgical Oncology.
PY - 2021/12
Y1 - 2021/12
N2 - Background: Differences in patient characteristics and decision-making preferences have been described between those who elect breast-conserving surgery (BCS), unilateral mastectomy (UM), or contralateral prophylactic mastectomy (CPM) for breast cancer. However, it is not known whether preferred and actual decision-making roles differ across these surgery types, or whether surgery choice reflects a woman’s goals or achieves desired outcomes. Methods: Women diagnosed with stage 0–III unilateral breast cancer across eight large medical centers responded to a mailed questionnaire regarding treatment decision-making goals, roles, and outcomes. These data were linked to electronic medical records. Differences were assessed using descriptive analyses and logistic regression. Results: There were 750 study participants: 60.1% BCS, 17.9% UM, and 22.0% CPM. On multivariate analysis, reducing worry about recurrence was a more important goal for surgery in the CPM group than the others. Although women’s preferred role in the treatment decision did not differ by surgery, the CPM group was more likely to report taking a more-active-than-preferred role than the BCS group. On multivariate analysis that included receipt of additional surgery, posttreatment worry about both ipsilateral and contralateral recurrence was higher in the BCS group than the CPM group (both p < 0.001). The UM group was more worried than the CPM group about contralateral recurrence only (p < 0.001). Conclusions: Women with CPM were more likely to report being able to reduce worry about recurrence as a very important goal for surgery. They were also the least worried about ipsilateral breast recurrence and contralateral breast cancer almost two years postdiagnosis.
AB - Background: Differences in patient characteristics and decision-making preferences have been described between those who elect breast-conserving surgery (BCS), unilateral mastectomy (UM), or contralateral prophylactic mastectomy (CPM) for breast cancer. However, it is not known whether preferred and actual decision-making roles differ across these surgery types, or whether surgery choice reflects a woman’s goals or achieves desired outcomes. Methods: Women diagnosed with stage 0–III unilateral breast cancer across eight large medical centers responded to a mailed questionnaire regarding treatment decision-making goals, roles, and outcomes. These data were linked to electronic medical records. Differences were assessed using descriptive analyses and logistic regression. Results: There were 750 study participants: 60.1% BCS, 17.9% UM, and 22.0% CPM. On multivariate analysis, reducing worry about recurrence was a more important goal for surgery in the CPM group than the others. Although women’s preferred role in the treatment decision did not differ by surgery, the CPM group was more likely to report taking a more-active-than-preferred role than the BCS group. On multivariate analysis that included receipt of additional surgery, posttreatment worry about both ipsilateral and contralateral recurrence was higher in the BCS group than the CPM group (both p < 0.001). The UM group was more worried than the CPM group about contralateral recurrence only (p < 0.001). Conclusions: Women with CPM were more likely to report being able to reduce worry about recurrence as a very important goal for surgery. They were also the least worried about ipsilateral breast recurrence and contralateral breast cancer almost two years postdiagnosis.
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U2 - 10.1245/s10434-021-10426-y
DO - 10.1245/s10434-021-10426-y
M3 - Article
C2 - 34275044
AN - SCOPUS:85110783803
VL - 28
SP - 8752
EP - 8765
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 13
ER -