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 One study surveyed 487 women after they underwent either a
lumpectomy that removes malignant tissue while sparing the rest of
the breast, a mastectomy that removes the entire breast, or both
procedures.
Regardless of what path they took, at least one in five women said
choosing quickly was more important than making an informed
decision, and at least as many patients felt like they didn’t have
all the facts before their operations.
“A breast cancer diagnosis can feel like an emergency when you are
the patient,” said lead study author Dr. Sunny Mitchell, a breast
surgeon in Stratford, Connecticut.
“There is actually plenty of time to review all treatment options
since survival rates are very high for early-stage breast cancer and
do not change if a woman starts treatment within a few weeks,”
Mitchell said by email.
Most early-stage breast cancer patients have either a lumpectomy or
a mastectomy, and many of them get chemotherapy or radiation
afterward to destroy any remaining abnormal cells and reduce the
risk of cancer coming back.
In the survey, only 47 percent of lumpectomy patients, 67 percent of
mastectomy patients, and 28 percent of women who had both procedures
said they felt completely informed before they had these surgeries,
Mitchell and colleagues found.
A quick decision was more important than an informed decision for 35
percent of the lumpectomy patients, 31 percent of the mastectomy
patients, and 22 percent of the women who had both procedures.
A separate study in the same journal offers one way to help women
understand their options.
For that study, researchers randomly assigned 227 women newly
diagnosed with breast cancer to use an online decision-making tool
or to read materials available on websites run by groups like the
American Cancer Society and the National Cancer Institute.
All of the women participated in the study before their first
surgical consultation.
With the decision aid, half of the women scored at least 80 out of
100 on tests of their knowledge about breast cancer and treatment
options, compared with a median score of 66 for women who reviewed
material on various websites.
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At the same time, 72 percent of the women who used the decision aid
recognized that they could wait a few weeks to make an informed
treatment choice without affecting their survival odds, compared
with just 54 percent for the other women.
“Women benefit from receiving high-quality information about breast
cancer prior to their first visit with a surgeon,” senior study
author Dr. Heather Neuman, a researcher at the University of
Wisconsin School of Medicine and Public Health in Madison, said by
email.
Decision aids can help women clarify their personal values and
preferences, for example by focusing on whether they want to avoid
radiation or concentrate on preserving their breasts, said Dr. Clara
Lee, a cancer researcher at The Ohio State University Wexner Medical
Center in Columbus.
This process can also prepare women to talk to their provider about
treatment options and make an informed decision, Lee, who wasn’t
involved in the study, said by email.
Women can still make an educated choice, aided by information
online, even when they don’t use a decision aid, Lee added.
“Women should look for information that presents multiple treatment
options and the pros and cons of those options – not just the pros,”
Lee advised. “Making a decision is about more than just information;
it’s also about being clear on what is important to you and being
prepared to discuss these things actively with your provider.”
SOURCES: http://bit.ly/2EvQygi and http://bit.ly/2Ev7wLP Journal of
the American College of Surgeons, online December 12, 2017.
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