ASO Visual Abstract: Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy: Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients

35 Background: The impact of high anxiety on surgical decision making has been demonstrated in various cancer settings. For patients undergoing neoadjuvant therapy (NAT) for breast cancer, supportive services can be offered prior to surgery and may help them choose between the options of bilateral mastectomy, unilateral mastectomy, or breast conserving surgery (BCS) where clinically appropriate. However, the effect of anxiety at initial diagnosis and psychological support on these decisions has not yet been studied. Methods: A prospective database of breast cancer patients treated with NAT at the British Columbia Cancer Agency was utilized to extract demographic information, surgical plan with regards to BCS and unilateral or bilateral mastectomy, and information about supportive services utilized. This was correlated with anxiety scores at initial consultation recorded by the Edmonton Symptom Assessment System and the Psychosocial Screen for Cancer. Patients were excluded if they had bilateral breast cancer, BRCA mutation, or missing data. Fisher’s exact tests were applied for statistical analysis. Results: From 2012-2016, 361 potential patients were identified. In total, 203 patients met eligibility criteria: 93 patients (46%) had low anxiety and 110 patients (54%) had high anxiety. Patients with high self-reported anxiety at initial consultation were 19% more likely to undergo aggressive surgery (bilateral mastectomy for unilateral disease or mastectomy for BCS eligible disease) than those with low self-reported anxiety at initial consultation (37% VS 18%; p = 0.003). Of the 110 patients with high anxiety, only 46 patients (42%) utilized counselling before surgery. No significant difference in rate of aggressive surgery was observed in patients with high anxiety who had counselling compared to those who did not (33% VS 41%; p = 0.43). Conclusions: High anxiety at initial consultation is associated with a 19% increase in aggressive surgery compared to patients with low anxiety. Counselling resources are currently underutilized by eligible patients, but this did not have an impact on surgical decision making in this study. This may be an area of opportunity for further research.

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Impact of Multigene Panel Testing on Surgical Decision Making in Breast Cancer Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.12.037 ◽

2018 ◽

Vol 226 (4) ◽

pp. 560-565 ◽

Cited By ~ 10

Author(s):

Holly J. Pederson ◽

Dharmesh Gopalakrishnan ◽

Ryan Noss ◽

Courtney Yanda ◽

Charis Eng ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Surgical Decision ◽

Panel Testing ◽

Multigene Panel Testing ◽

Surgical Decision Making ◽

Multigene Panel

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Decision aids on breast conserving surgery for early stage breast cancer patients: a systematic review

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01295-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jing Si ◽

Rong Guo ◽

Xiang Lu ◽

Chao Han ◽

Li Xue ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Patients ◽

Early Stage ◽

Decision Aids ◽

Breast Conserving Surgery ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Surgical Decision ◽

Surgical Decision Making

Abstract Background Breast cancer is a worldwide health concern. For early stage breast cancer patients, choosing the surgical method after diagnosis is always a dilemma. Decision aids designed for use by patients are tools which may help with surgical decision making for these patients. Methods We screened through MEDLINE, EMBASE, PubMed and Web of Science using the inclusion criteria which included (1) newly diagnosed patients with early stage breast cancer, (2) outcomes/results involving surgical options including breast conserving surgery. The search strategy used these key words or the combination of these words: “breast cancer”, “decision aid”, “decision making”, “decision support”, “breast conserving surgery”, “breast conserving therapy”. Results A total of 621 studies were identified, but only seven studies were included. Results were synthesized into narrative format. Various patterns of decision aids designed for use by patients were implemented. Mostly were educational materials via booklet, video or CDROM with or without assistance from surgeons. After decision aids, four studies showed that patients were more likely to change their original choices into mastectomy or modified radical instead of sticking to breast conserving surgery. Other results such as knowledge of breast cancer and treatments, decisional conflict and satisfaction, psychological changes after surgery and quality of life were all showed with a better trend in patients with decision aids in most studies. Conclusion Decision aids on breast conserving surgery made it easier for patient involvement in surgical decision making and improved decision-related outcomes in most early stage breast cancer patients. With more attention, improving procedures, and better interdisciplinary cooperation, more research is necessary for the improvement of decision aids. And we believe decision aids with agreed objective information are needed.

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