Doctor-Patient Talks May Impact Care of Elderly Bca Pts

Doctor-Patient Talks May Impact Breast Cancer Care

Fri Mar 29,10:13 AM ET By Jacqueline Stenson

NEW YORK (Reuters Health)

Doctors who spend some extra time talking with their elderly breast cancer patients about treatment options and concerns regarding surgery can improve care and boost patient satisfaction too, a study finds.

Compassion appeared to be the key determinant of whether the patients, all of whom had early-stage breast cancer that had not spread, were satisfied with their care, results indicate.

Patients who said their doctors initiated a lot of communication about the women's worries and opinions about the disease were more than twice as likely to say they were satisfied with their care than patients whose doctors asked fewer such questions.

"There are two components of communication here--one is for the technical information and one is more about caring, talking about patients' concerns," said study author Dr. Wenchi Liang, a cancer researcher at Georgetown University Medical Center in Washington, DC. "A caring attitude is a strong factor for satisfaction."

The study, published in a recent issue of the Journal of Clinical Oncology, involved 613 mostly white women aged 67 and older who had been treated for early-stage breast cancer 3 to 6 months prior to being interviewed about their care. Liang noted that while most doctors are pretty good at discussing treatment options, they may fall short when it comes to addressing the emotional issues surrounding surgery, either because they don't have good skills in this area or they are too pressed for time.

But thorough treatment discussions have their merits, too. In the study, women who said their doctors discussed the most treatment options with them were one-third more likely than other women to receive breast-conserving surgery, such as lumpectomy, followed by radiation, rather than undergoing a complete breast removal (mastectomy) or breast-conserving surgery without radiation.

Survival rates are similar for mastectomy and breast-conserving surgery plus radiation, Liang said, though many doctors recommend--and women often prefer--the latter because it preserves more breast tissue. However, some elderly women do not opt for breast-conserving surgery because they don't want to keep going back to the hospital for the recommended follow-up radiation treatment.

And older women who have breast-conserving surgery are less likely to undergo the radiation therapy than younger women, according to Liang. But the new study found that women who had detailed treatment discussions with their doctors were most likely to complete the radiation as advised.

Research has indicated that older breast cancer patients tend to seek less medical information than their younger counterparts, perhaps because they are uncomfortable asking questions, or they don't know how to raise questions, Liang said. But informed choices are better choices, she stressed. "If they feel they can't ask questions then they should have a friend or relative ask for them," she advised.

SOURCE: Journal of Clinical Oncology 2002;20:1008-1016.

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