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Long-term Care

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Better doctor-patient communication could enhance the quality of care for older women with breast cancer

Both breast-conserving surgery (BCS) with radiation therapy (RT) and mastectomy have equal survival rates for early-stage breast cancer. Despite the increasing use of BCS over the past decade, older women with breast cancer receive BCS less often than younger women, and sometimes RT is omitted after BCS. Yet older women who are told about treatment options by their surgeons are much more likely to get BCS with radiation than other types of treatment. They also are more likely to have a sense of treatment choice and be more satisfied with care, according to a study supported by the Agency for Healthcare Research and Quality (HS08395).

First author, Wenchi Liang, M.D., of Georgetown University Medical Center, and colleagues analyzed data from 613 surgeons and their patients who had been diagnosed with localized breast cancer. Patients were aged 67 and older, and most were white, middle class women who participated in a nationwide study on breast cancer treatment options. Patients were asked about who initiated communication and the number of treatment options discussed in order to examine the relationship between communication and outcomes.

Women who reported that their surgeons mentioned more treatment options were twice as likely as other women to report being given a treatment choice, and they were 33 percent more likely to get BCS with RT than other types of treatment. Surgeons who were trained in surgical oncology or who treated a high volume of breast cancer patients (75 percent or more of their practice) were nearly twice as likely as other surgeons to have their patients indicate that they initiate communication with patients.

A high degree of physician-initiated communication, in turn, was associated with patients' perception of having a treatment choice and satisfaction with breast cancer care in the 3 to 6 months after surgery. The researchers conclude that breast cancer care for older women can be improved by implementing a physician communication style that includes a caring attitude and providing patients with comprehensive information.

See "Communication between physicians and older women with localized breast cancer: Implications for treatment and patient satisfaction," by Dr. Liang, Caroline B. Burnett, R.N., Sc.D., Julia H. Rowland, Ph.D., and others, in the February 15, 2002, Journal of Clinical Oncology 20(4), pp. 1008-1016.

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