Why most women with breast cancer still undergo mastectomy

Breast cancer diagnosis and factors influencing treatment decisions in Ghana

Researchers in this study explored the reactions of women with breast cancer and identified factors influencing treatment decisions. A qualitative exploratory approach was employed. Participants were recruited from a tertiary hospital and a breast cancer support group. Purposive sampling recruited 12 women. It was found that women identified breast lesions accidentally or intentionally and that diagnosis was delayed. Emotional reactions to diagnosis included shock and sadness. Factors that influenced treatment were the influence of other people, alternative sources of treatment, faith and support, knowledge, "tuning the mind," and effects on intimacy. Health professionals should develop effective communication and counseling skills for clients.

Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008)

CONTEXT AND OBJECTIVE

Recently, breast-conserving surgery (BCS) has been replacing mastectomy for breast cancer treatment. The aim of this study was to evaluate the changes in mastectomy and BCS rates and the factors relating to these shifts.

DESIGN AND SETTING

A retrospective study in a Brazilian public hospital.

METHODS

Pathological records from female patients who underwent surgery for breast cancer at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), between 1989 and 2008 were reviewed. The mastectomy and BCS rates were calculated. The chi-square test was used to assess factors associated with type of surgical treatment and to compare trends in treatment type over the years. Logistic regression was used for multivariate analysis.

RESULTS

From 1989 to 2008, 2050 breast cancer surgical specimens were received in our service, corresponding to 1973 patients; 1324 (64.6%) of them were from mastectomy and 726 (35.4%) from BCS. A shift from mastectomy towards BCS was observed (P < 0.001). In multivariate analysis, earlier year of surgery (P < 0.001), larger tumor size (P < 0.001), having at least one positive axillary lymph node (P < 0.001) and patients' age greater than 68 years (P = 0.007) were predictors of mastectomy.

CONCLUSIONS

There was a shift from mastectomy towards BCS in our institution over the years. This may reflect consolidation of BCS (plus radiotherapy) as an equivalent treatment to mastectomy in terms of survival and a shift to earlier diagnosis for the disease.

Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy

OBJECTIVE

To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients.

METHODS

Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted.

RESULTS

Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group.

CONCLUSIONS

Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options.

PRACTICE IMPLICATIONS

Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers).

Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?

OBJECTIVE

To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM).

BACKGROUND

A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices.

DESIGN

Literature search and narrative synthesis of data.

SYNTHESIS

Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients.

CONCLUSIONS

The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.

Consumer health informatics: an overview of patient perspectives on health information needs

Patients are increasingly expressing their need for more information about their health. Different healthcare professionals provide a range of information to their patients during delivery of care. By means of a detailed literature search and a study of available evidence, this article explores patients' perspectives in gaining health-related information from the healthcare system, with particular emphasis on patients who come in contact with breast cancer services. The literature review indicates that the main issues concerning health information available to consumers can be divided into the following sections: quantity of information (amount of information, number of sources, types and strategies for distribution); quality of information (validity, relevance, accessibility, understandability, timing of acquisition); and consumer/patient factors (age, health status, empowerment to make decisions). Information-seeking behaviour of consumers should be considered as part of a broader environmental and role-related context. The acquisition of information and the decision to seek information (either personally or using the help or services of other people) is affected by stress, perception of risk, hope for reward and perceived level of self-efficacy.

Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid

BACKGROUND

We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions.

METHOD

We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid.

RESULTS

Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment.

CONCLUSION

The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users.