Identifying Preferences For Breast Cancer Surgery Options: An Update
Toni Storm-Dickerson1, Allen Gabriel2, Matthew Gitlin3.
1Compass Oncology, Vancouver, WA, USA, 2Private Practice, Vancouver, WA, USA, 3BluePath Solutions, Los Angeles, CA, USA.
BACKGROUND: Previous research in predominantly Caucasian women has shown that surgical choices for breast cancer are impacted by many factors beyond survival. We sought to update this research in women of different race/ethnic descent including Asian, Black, Hispanic, and Caucasian.
METHODS: A web-based survey using an Adaptive Choice-Based Conjoint (ACBC) design was used to assess adult female decision-making regarding breast surgery treatment options. The study was conducted in the fall of 2018 using a National Representative Market Research Database of adults. A purposeful sample of women ≥ 18 years old with no current breast cancer, representing four unique cohorts, including Asian, Black, Caucasian, and Hispanic were evaluated. The survey quantified the relative importance of 9 attributes, including clinical, humanistic outcomes and surgical treatment characteristics. The importance was expressed as a percentage (total 100%) to reflect the proportion of the overall treatment decision that was accounted for by each factor.
RESULTS: A total of 200 women per cohort participated in the survey. There were significant differences in demographics and beliefs between cohorts. Importantly, the level of education varied significantly between groups, with more Asian women (68%) having a higher education compared to Black women (26%). Doctor’s recommendation was the most important attribute in making a surgical choice for Black, Caucasian, and Hispanic women whereas out-of-pocket costs was the highest rated attribute for Asian women. The next two top attributes for the overall sample and cohorts were:
• Overall sample (N=800): out-of-pocket costs, breast look
• Asian (n=200): doctor’s recommendation, breast look
• Black (n=200): breast look, surgery time/recovery
• Caucasian (n=200): 20-year survival, breast look
• Hispanic (n=200): out-of-pocket costs, breast look
Factors such as radiation use, nipple characteristics, and 10-year recurrence were generally rated of lower importance by these women.
CONCLUSIONS: Doctor’s recommendation, out of pocket costs and breast look were generally the factors of greatest importance. When considering a population of women faced with choosing a surgery approach, the importance of race/ethnicity may impact the type of education provided, illustrating the importance of patient education on shared decision making for all patients regardless of perceived interest or social and economic status.
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