The influence of patients' concerns on surgeons' recommendations for early breast cancer

This paper examines whether an older patient's concerns about surgical treatment of breast cancer--such as fear of dying or about losing a breast--affect the treatment recommendations by their surgeons. A sample of 137 older women diagnosed with early stage breast cancer between 1994 and 1996 were interviewed within 2 months of diagnosis to determine demographic characteristics, their attitudes about breast cancer treatments, and which surgical treatment their surgeon initially recommended. The treatment preferences of the 35 surgeons treating these women were ascertained by asking them what treatment they would usually recommend to a hypothetical 75-year-old woman with early stage breast cancer. Patients who reported their feelings about losing a breast as 'very important' were less likely to be recommended mastectomy (Odds Ratio (OR) = 0.39; 95% (Confidence Interval) CI 0.16, 0.94), while patients who reported fear of dying from breast cancer as 'very important' were more likely to be recommended mastectomy (OR = 4.60; 95% CI 1.94, 11.59), after adjusting for surgeons' age and the surgeons' treatment preference when presented with a hypothetical patient. It is concluded that surgeons integrate patients' attitudes and concerns into their treatment recommendations.