Breast cancer patients who lack knowledge about their own tumor are less likely to receive recommended treatment, study finds

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Women with breast cancer who know the characteristics of their tumor are more likely to receive the treatment recommended for their type of cancer, Dana-Farber Cancer Institute investigators report in a new study that reinforces the potential risks of being underinformed about one’s cancer.

The study, published today by the Journal of Oncology Practice, is based on a survey of more than 400 patients who were asked the stage and grade of their breast cancer, whether it tested positive for the HER2 protein, and whether it was sensitive to estrogen. Each of these factors influences the treatment regimen that patients receive.

Patients who correctly reported their breast cancer as HER2-positive were likely to receive chemotherapy, the recommended treatment for that form of the disease. Those who correctly reported their cancer as estrogen-sensitive were likely to receive hormonal therapy, as treatment guidelines advise. And those who correctly identified their tumor stage were likely to receive radiation therapy. By contrast, patients who were less knowledgeable about their cancer were less likely to receive the recommended treatment.

“Previous studies have shown that knowledge about breast cancer in general is poor across many populations, but what isn’t known is whether knowledge of one’s own disease affects one’s receipt of treatment,” says study lead author Rachel Freedman, MD, MPH, of the Susan F. Smith Center for Women’s Cancers at Dana-Farber. “For this study, we hypothesized that such knowledge is associated with receiving the recommended therapies. Our findings support that hypothesis.”

She notes that although the link between knowledge and appropriate treatment was confirmed by the study’s results, the direction of that link is unclear. In other words, are women apt to receive the recommended treatment because they’re knowledgeable about their disease, or are they knowledgeable about their disease because they’ve received the recommended treatment?

Freedman and her colleagues are planning a study to answer this and other questions about patients’ understanding of their disease and the decisions surrounding its treatment. “We want to focus specifically on the clinical, emotional, and social consequences of poor knowledge and how information can be delivered to patients more effectively,” she remarks. “The next step will be to test whether efforts to improve patients’ knowledge can lead to better care.”

The senior author of the study is Nancy Keating, MD, MPH, of Dana-Farber and Brigham and Women’s Hospital (BWH). Co-authors are Elena Kouri, PhD, Dee West, PhD, and Joyce Lii, MS, all of Dana-Farber and BWH.

Financial support for the study was provided by grants from Susan G. Komen, the American Cancer Society, and National Cancer Institute (grant no. K24CA181510).


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