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Clinical Decisionmaking

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Older women who have breast cancer recover faster and have a more positive outlook when they are offered treatment choices

Two surgical alternatives with equivalent survival are available for women with early-stage breast cancer: mastectomy (surgical breast removal) and breast conservation surgery (BCS, removing only the cancerous lump). In most patients, the treatment choice reflects the preferences of patients and physicians, and appropriateness of treatment is not an issue. A recent study supported by the Agency for Healthcare Research and Quality (HS08395) found that older women (aged 67 or older) who participate with their doctor in choosing which treatment they receive tend to recover faster and have a more positive outlook in the short-term than women who are not given a choice.

Lead author Daniel Polsky, Ph.D., of the University of Pennsylvania, and his colleagues surveyed 683 older women with localized breast cancer who were treated at one of 29 hospitals in Massachusetts, Texas, Washington, DC, and New York. Patients were surveyed at 5 months, 1 year, and 2 years following surgery for breast cancer. They were asked whether they had a choice in their treatment and how they assessed their current health.

Women assessed their health using a visual analog scale (VAS) and the Multi-Attribute Health Status Classification System: Health Utilities Index Mark 3 (HUI3). Using the VAS, women rated their current health status on a scale from 0 (worst imaginable health state) to 100 (best imaginable health state). The women used the HUI3 to rate each of eight health attributes (vision, hearing, speech, emotional function, dexterity, ambulatory function, pain, and cognitive function) and to provide a summary health rating.

Overall, 83 percent of women studied said they had a treatment choice. Five months after surgery, women who had a choice of treatment assessed their overall health more than 3 points higher on the VAS than those who had no choice, a significant difference. However, their VAS scores were insignificantly higher 1 and 2 years after surgery.

The only HUI score that was significantly higher for the choice group was emotional health. It was 2 points higher at 5 months and 3 points higher 1 year after surgery, suggesting a better short-term outlook for women with a choice. Women who felt they had a choice also received fewer medical services after treatment than women who did not have a choice, indicating they may have had an easier recovery from surgery and fewer complications.

More details are in "Patient choice of breast cancer treatment: Impact on health state preferences," by Dr. Polsky, Nancy L. Keating, M.D., M.P.H., Janice C. Weeks, M.D., and Kevin A. Schulman, M.D., in Medical Care 40(11), pp. 1068-1079, 2002.

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