Women's lack of knowledge and mistrust play a role in underuse of breast cancer adjuvant therapy
Research Activities, April 2010
Despite the proven effectiveness of postsurgical adjuvant therapies in the treatment of early-stage breast cancer, many women do not receive them. According to a new survey, 32 of 258 women who should have received adjuvant therapy (chemotherapy, hormonal therapy, or radiotherapy) did not. The principal factors associated with lack of adjuvant treatment were being 70 years or older, having other illnesses, and expressing mistrust in the medical delivery system.
The survey included questions about trust of physician, physician communication about treatment, trust of hospitals, knowledge and belief about adjuvant treatment, racism, self-efficacy, and instrumental and emotional social support. Untreated women reported lower levels of self-efficacy than treated women, were less likely to know that adjuvant therapies have been proven to increase survival, and were more likely to believe them to be harmful. The researchers were disturbed that women's knowledge of treatment benefits and risks were not affected by their physicians' communications about treatment. Women with less than a high school education expressed more mistrust than women who had a high school education or more.
The 258 patients selected for the study were all women with stage I or II breast cancer who had surgery 6 or more months prior to the survey. Based on practice guidelines, among the 258 women, 64 should have received chemotherapy, 150 should have received hormonal therapy, and 174 should have received radiotherapy. Yet, 12.5 percent, 7.3 percent, and 8.6 percent of these groups, respectively, were untreated. To reduce underuse of adjuvant therapies, the researchers recommend that all women should be educated regarding the benefits and risks of treatment. Physicians should also directly address issues of trust, particularly with minority populations and patients with other illnesses in addition to breast cancer. This study was supported by the Agency for Healthcare Research and Quality (HS10859).
See "Underuse of breast cancer adjuvant treatment: Patient knowledge, beliefs, and medical mistrust," by Nina A. Bickell, M.D., M.P.H., Jessica Weidmann, Kezhen Fei, M.S., and others in the November 1, 2009 Journal of Clinical Oncology 27(31), pp. 5160-5167.