Breast Cancer Treatment, part 2

Breast Cancer Treatment, part 2

MATERIALS AND METHODS
The study design consisted of 76 women (average age
54.6, SD = 13.71) treated by academic surgeons at the H.
Lee Moffitt Cancer Center and Research Institute (Tampa,
FL). Patients underwent a lumpectomy (36/76, 47%) or
mastectomy (40/76, 53%) for treatment of breast cancer.
Of these women, 68% (52/76) were married. After giving
informed consent, 45/76 patients (59%) were interviewed
in person during a postoperative follow-up visit, which
occurred within 1 month of surgery. The remaining 31/
76 (41 %) were contacted via phone interview and mailing.
The average period elapsed since surgery was 1.26
months .
Subjects completed a seven-item questionnaire that
probed the decision-making process used by the surgeon
and patient to arrive at their treatment plan. Patients also
completed the Miller Behavioral Style Scale (MBSS) to
classify individuals as using either monitor or blunter
coping styles [4]. Miller et al. [4] offer several alternatives
for scoring the MBSS. Patients who scored above the
median on the monitor subscale and below the median
on the blunter subscale were classified as monitors. Conversely,
those scoring above the median on the blunter
subscale and below the median on the monitor subscale
were classified as blunters. Cross-tabulation analysis was
then used to compare these two subsamples on their decision-
making questionnaire answers.

RESULTS
Although 79.7% of women wanted a role in the decision-
making process, 73.6% of those in the study wanted
their physicians to make a recommendation (Table I).
Among women given a recommendation the overwhelming
majority (93.8%) followed the physician’s treatment
plan. When asked if they had specific fears about facing
breast cancer, 76.3% of women responded yes, but only
55% of these women actually told their physicians or
other health care providers about these fears. For example,
these specific fears included anxiety about losing a breast,
chemotherapy, and fears of dying before their children
are grown. Consequently, 45% of women had their fears
unrecognized by a health care provider and thus could
not be offered counseling.
Although previous work by Miller et al. [4] attempted
to categorize patients as either monitors or blunters, these
data show that only 38/76 (50%) of patients could be
distinctly placed in either category. The remaining 38/76
(50%) of patients employed a combination of both coping
responses. Using the criteria outlined above, only 15 of
76 (20%) patients could be categorized clearly as monitors
and 23 of 76 (30%) as blunters. Surprisingly, blunters
were not more likely to desire a physician’s recomrnendation.
Both monitors and blunters were equally likely to
have specific fears about facing breast cancer, and monitors
were no more likely than blunters to tell their physicians
of their fears (75% monitors vs. 47.3% blunters,
not statistically significant).
To explore age-related differences, the sample was split
at the median age to compare patients age 53 and over
to those age 52 and under. According to the patients’
reports, physicians were equally likely to make treatment
recommendations to both older and younger patients.
However, women age 52 and under were more likely to
want their doctors to make a recommendation (Chi square
5.14, df 1, P = .023). Visual inspection of the data shows
that all of the women age 40 and under (n = 14) wanted
a physician’s recommendation. Older women were less
likely to have specific fears about facing breast cancer
(Chi square = 13.33, df 1, P = .0002).
In response to the question “What suggestions would
you make regarding the doctor’s or patient’s role in making
decisions about the type of surgery?’ 32% of patients
suggested that physicians should educate their patients
more about breast cancer so that they can make a more
informed decision. One-quarter of subjects also suggested
that patients should assume the responsibility of educating
themselves in order to participate more effectively in
decision making. An additional 21 % believe physicians
should spend more time with their patients.