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Padamsee TJ, Bijou C, Swinehart-Hord P, Hils M, Muraveva A, Meadows RJ, Shane-Carson K, Yee LD, Wills CE, Paskett ED. Risk-management decision-making data from a community-based sample of racially diverse women at high risk of breast cancer: rationale, methods, and sample characteristics of the Daughter Sister Mother Project survey. Breast Cancer Res 2024; 26:8. [PMID: 38212792 PMCID: PMC10785448 DOI: 10.1186/s13058-023-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To understand the dynamics that limit use of risk-management options by women at high risk of breast cancer, there is a critical need for research that focuses on patient perspectives. Prior research has left important gaps: exclusion of high-risk women not in risk-related clinical care, exclusion of non-white populations, and lack of attention to the decision-making processes that underlie risk-management choices. Our objective was to create a more inclusive dataset to facilitate research to address disparities related to decision making for breast cancer risk management. METHODS The Daughter Sister Mother Project survey collects comprehensive information about the experiences of women at high risk of breast cancer. We collected novel measures of feelings about and reactions to cancer screenings; knowledge, barriers, and facilitators of risk-management options; beliefs related to cancer risk and risk management; and involvement with loved ones who had cancer. Eligible individuals were non-Hispanic white and non-Hispanic Black adult women who self-identified as having high risk of breast cancer and had no personal history of cancer. Between October 2018 and August 2019, 1053 respondents completed the online survey. Of these, 717 were confirmed through risk prediction modeling to have a lifetime breast cancer risk of ≥ 20%. Sociodemographic characteristics of this sample were compared to those of nationally representative samples of the US population: the 2019 Health Information National Trends Survey and the Pew Research Center report: Jewish Americans in 2020. RESULTS The sample of 717 women at objectively high risk of breast cancer was largely (95%) recruited from non-clinical sources. Of these respondents, only 31% had seen a genetic counselor, 34% had had genetic testing specific to breast cancer risk, and 35% had seen at least one breast or cancer care specialist. The sample includes 35% Black respondents and 8% with Ashkenazi Jewish ancestry. Although encompassing a substantial range of ages, incomes, and education levels, respondents are overall somewhat younger, higher-income, and more educated than the US population as a whole. CONCLUSIONS The DSM dataset offers comprehensive data from a community-based, diverse sample of women at high risk of breast cancer. The dataset includes substantial proportions of Black and Ashkenazi Jewish women and women who are not already in clinical care related to their breast cancer risk. This sample will facilitate future studies of risk-management behaviors among women who are and are not receiving high-risk care, and of variations in risk-management experiences across race and ethnicity.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
| | - Christina Bijou
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Megan Hils
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Anna Muraveva
- Government Resources Center, The Ohio State University, Columbus, OH, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | | | - Lisa D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Celia E Wills
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Espinel W, Champine M, Hampel H, Jeter J, Sweet K, Pilarski R, Pearlman R, Shane K, Brock P, Westman JA, Kipnis L, Sotelo J, Chittenden A, Culver S, Stopfer JE, Schneider KA, Sacca R, Koeller DR, Gaonkar S, Vaccari E, Kane S, Michalski ST, Yang S, Nielsen SM, Bristow SL, Lincoln SE, Nussbaum RL, Esplin ED. Clinical Impact of Pathogenic Variants in DNA Damage Repair Genes beyond BRCA1 and BRCA2 in Breast and Ovarian Cancer Patients. Cancers (Basel) 2022; 14:cancers14102426. [PMID: 35626031 PMCID: PMC9139211 DOI: 10.3390/cancers14102426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary The clinical utility of positive findings in DNA damage-repair (DDR) genes BRCA1 and BRCA2 for the treatment of patients with breast or ovarian cancer is well established. However, multigene panel genetic testing for patients with breast and ovarian cancer now commonly includes DDR genes in addition to BRCA1 and BRCA2, a number of which are considered moderate or low-risk genes. This study aimed to describe the clinical utility of positive results from genetic testing when the findings were in one of these other DDR genes. In a group of 101 women with positive findings in a cancer gene other than BRCA1 or BRCA2 (often in a DDR gene), nearly three-fifths (58%) had a clinical recommendation made based on their positive genetic test result and two-thirds (65%) had the clinician make recommendations for family members that may be at risk. This real-world data provides evidence that positive findings from genetic testing for moderate and low-risk genes, including DDR genes, can have clinical utility and can impact a patient’s clinical management. Abstract Consensus guidelines for hereditary breast and ovarian cancer include management recommendations for pathogenic/likely pathogenic (P/LP) variants in ATM, CHEK2, PALB2, and other DNA damage repair (DDR) genes beyond BRCA1 or BRCA2. We report on clinical management decisions across three academic medical centers resulting from P/LP findings in DDR genes in breast/ovarian cancer patients. Among 2184 patients, 156 (7.1%) carried a P/LP variant in a DDR gene. Clinical follow-up information was available for 101/156 (64.7%) patients. Genetic test result-based management recommendations were made for 57.8% (n = 59) of patients and for 64.7% (n = 66) of patients’ family members. Most recommendations were made for moderate-to-high risk genes and were consistent with guidelines. Sixty-six percent of patients (n = 39/59) implemented recommendations. This study suggests that P/LP variants in DDR genes beyond BRCA1 and BRCA2 can change clinical management recommendations for patients and their family members, facilitate identification of new at-risk carriers, and impact treatment decisions. Additional efforts are needed to improve the implementation rates of genetic-testing-based management recommendations for patients and their family members.
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Affiliation(s)
- Whitney Espinel
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (W.E.); (M.C.)
| | - Marjan Champine
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA; (W.E.); (M.C.)
| | - Heather Hampel
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Joanne Jeter
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Kevin Sweet
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Robert Pilarski
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Rachel Pearlman
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Kate Shane
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Pamela Brock
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Judith A. Westman
- Ohio State University Medical Center, Columbus, OH 43210, USA; (H.H.); (J.J.); (K.S.); (R.P.); (R.P.); (K.S.); (P.B.); (J.A.W.)
| | - Lindsay Kipnis
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Jilliane Sotelo
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Anu Chittenden
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Samantha Culver
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Jill E. Stopfer
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Katherine A. Schneider
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Rosalba Sacca
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Diane R. Koeller
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Shraddha Gaonkar
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Erica Vaccari
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Sarah Kane
- Dana Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (J.S.); (A.C.); (S.C.); (J.E.S.); (K.A.S.); (R.S.); (D.R.K.); (S.G.); (E.V.); (S.K.)
| | - Scott T. Michalski
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Shan Yang
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Sarah M. Nielsen
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Sara L. Bristow
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Stephen E. Lincoln
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Robert L. Nussbaum
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
| | - Edward D. Esplin
- Invitae, San Francisco, CA 94103, USA; (S.T.M.); (S.Y.); (S.M.N.); (S.L.B.); (S.E.L.); (R.L.N.)
- Correspondence: ; Tel.: +1-800-436-3037
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Illness perceptions and adherence to breast cancer-related lymphedema risk management behaviours among breast cancer survivors. Eur J Oncol Nurs 2022; 58:102144. [DOI: 10.1016/j.ejon.2022.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
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Campacci N, de Campos Reis Galvão H, Garcia LF, Ribeiro PC, Grasel RS, Goldim JR, Ashton-Prolla P, Palmero EI. Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome. Psychooncology 2020; 29:681-687. [PMID: 31984583 DOI: 10.1002/pon.5305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families' profiles and the challenges of the oncogenetics setting. METHODS This was a cross-sectional study in which interviews were conducted with 83 cancer-affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the "life course perspective" theory. RESULTS Individuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20-29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing. CONCLUSIONS This study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow-up and prevention strategies.
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Affiliation(s)
- Natalia Campacci
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Lucas F Garcia
- Programa de Pós-Graduação em Promoção da Saúde, Centro Universitário Cesumar, Maringá, Brazil
| | - Paula C Ribeiro
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Rebeca S Grasel
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - José R Goldim
- Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Patrícia Ashton-Prolla
- Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Laboratório de Medicina Genômica, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Edenir I Palmero
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Programa de Pós-Graduação em Genéticae Biologia Molecular (PPGBM), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Sao Paolo, Brazil
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Gunn CM, Bokhour BG, Parker VA, Battaglia TA, Parker PA, Fagerlin A, McCaskill-Stevens W, Bandos H, Blakeslee SB, Holmberg C. Understanding Decision Making about Breast Cancer Prevention in Action: The Intersection of Perceived Risk, Perceived Control, and Social Context: NRG Oncology/NSABP DMP-1. Med Decis Making 2019; 39:217-227. [PMID: 30803311 PMCID: PMC6538065 DOI: 10.1177/0272989x19827258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Literature on decision making about breast cancer prevention focuses on individual perceptions and attitudes that predict chemoprevention use, rather than the process by which women decide whether to take risk-reducing medications. This secondary analysis aimed to understand how women's perceptions of breast cancer risk and locus of control influence their decision making. METHODS Women were accrued as part of the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project 1, a study aimed at understanding contributors to chemoprevention uptake. Thirty women participated in qualitative in-depth interviews after being counseled about chemoprevention. Deductive codes grouped women based on dimensions of risk perception and locus of control. We used a constant comparative method to make connections among inductive themes focused on decision making, deductive codes for perceived risk and perceived locus of control, and the influence of explanatory models within and across participants. RESULTS Participants were predominantly non-Hispanic white (63%), with an average age of 50.9 years. Decision making varied across groups: the high-perceived risk/high-perceived control group used "social evidence" to model the behaviors of others. High-perceived risk/low-perceived control women made decisions based on beliefs about treatment, rooted in the experiences of social contacts. The low-perceived risk/low-perceived control group interpreted signs of risk as part of the normal continuum of bodily changes in comparison to others. Low-perceived risk/high-perceived control women focused on maintaining a current healthy trajectory. CONCLUSION "Social evidence" plays an important role in the decision-making process that is distinct from emotional aspects. Attending to patients' perceptions of risk and control in conjunction with social context is key to caring for patients at high risk in a way that is evidence based and sensitive to patient preferences.
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Affiliation(s)
- Christine M. Gunn
- Boston University School of Medicine, Section of General Internal Medicine, Women’s Health Unit, Boston, MA
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
| | - Barbara G. Bokhour
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
- Center for Healthcare Organization and Implementation Research Department of Veterans Affairs, Bedford, MA
| | - Victoria A. Parker
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
- University of New Hampshire, Durham, NH
| | - Tracy A. Battaglia
- Boston University School of Medicine, Section of General Internal Medicine, Women’s Health Unit, Boston, MA
| | - Patricia A. Parker
- Memorial Sloan Kettering Cancer Center, Psychiatry & Behavioral Sciences, New York, NY
| | - Angela Fagerlin
- University of Michigan, Ann Arbor, MI
- University of Utah School of Medicine, Department of Population Health Sciences, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT
| | - Worta McCaskill-Stevens
- NRG Oncology, Pittsburgh, PA
- Community Oncology and Prevention Trials Research Group, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Hanna Bandos
- NRG Oncology, Pittsburgh, PA
- The University of Pittsburgh, Pittsburgh, PA
| | - Sarah B. Blakeslee
- Institute of Public Health, Charité – Universitätsmedizin, Brandenburg, Berlin, Germany
| | - Christine Holmberg
- NRG Oncology, Pittsburgh, PA
- Institute of Public Health, Charité – Universitätsmedizin, Brandenburg, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
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Blakeslee SB, McCaskill-Stevens W, Parker PA, Gunn CM, Bandos H, Bevers TB, Battaglia TA, Fagerlin A, Müller-Nordhorn J, Holmberg C. Deciding on breast cancer risk reduction: The role of counseling in individual decision-making - A qualitative study. PATIENT EDUCATION AND COUNSELING 2017; 100:2346-2354. [PMID: 28734560 PMCID: PMC5683919 DOI: 10.1016/j.pec.2017.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/13/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis. RESULTS Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer. CONCLUSION Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations. PRACTICE IMPLICATIONS Individuals' health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients' experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.
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Affiliation(s)
- Sarah B Blakeslee
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health.
| | - Worta McCaskill-Stevens
- National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Bethesda, MD 20892, United States.
| | - Patricia A Parker
- The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, P.O. Box 301439, Unit Number: 1322, Houston, TX 77230-1439, United States.
| | - Christine M Gunn
- Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States
| | - Hanna Bandos
- NRG Oncology, Pittsburgh, United States; The University of Pittsburgh, 201 North Craig St., Suite 350, Pittsburgh, PA 15213, United States.
| | - Therese B Bevers
- The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, P.O. Box 301439, Unit Number: 1322, Houston, TX 77230-1439, United States.
| | - Tracy A Battaglia
- Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States.
| | - Angela Fagerlin
- Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS); Department of Population Health Sciences, University of Utah.
| | - Jacqueline Müller-Nordhorn
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health.
| | - Christine Holmberg
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health.
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Holmberg C, Bandos H, Fagerlin A, Bevers TB, Battaglia TA, Wickerham DL, McCaskill-Stevens WJ. NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project-1 Results: Decision Making in Breast Cancer Risk Reduction. Cancer Prev Res (Phila) 2017; 10:625-634. [PMID: 28978566 DOI: 10.1158/1940-6207.capr-17-0076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/06/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023]
Abstract
Selective estrogen receptor modulators (SERMs) reduce breast cancer risk. Adoption of SERMs as prevention medication remains low. This is the first study to quantify social, cultural, and psychologic factors driving decision making regarding SERM use in women counseled on breast cancer prevention options. A survey study was conducted with women counseled by a health care provider (HCP) about SERMs. A statistical comparison of responses was performed between those who decided to use and those who decided not to use SERMs. Independent factors associated with the decision were determined using logistic regression. Of 1,023 participants, 726 made a decision: 324 (44.6%) decided to take a SERM and 402 (55.4%) decided not to. The most important factor for deciding on SERM use was the HCP recommendation. Other characteristics associated with the decision included attitudes and perceptions regarding medication intake, breast cancer worry, trust in HCP, family members with blood clots, and others' experiences with SERMs. The odds of SERM intake when HCP recommended were higher for participants with a positive attitude toward taking medications than for those with a negative attitude (Pinteraction = 0.01). This study highlights the importance of social and cultural aspects for SERM decision making, most importantly personal beliefs and experiences. HCPs' recommendations play a statistically significant role in decision making and are more likely to be followed if in line with patients' attitudes. Results indicate the need for developing interventions for HCPs that not only focus on the presentation of medical information but, equally as important, on addressing patients' beliefs and experiences. Cancer Prev Res; 10(11); 625-34. ©2017 AACRSee related editorial by Crew, p. 609.
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Affiliation(s)
- Christine Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Hanna Bandos
- NRG Oncology, and The University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angela Fagerlin
- The University of Utah School of Medicine, Department of Population Health and The VA Salt Lake City, Salt Lake City, Utah.,University of Michigan and The VA Ann Arbor Center for Clinical Management, Ann Arbor, Michigan
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - D Lawrence Wickerham
- NRG Oncology and The Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Worta J McCaskill-Stevens
- Community Oncology and Prevention Trials Research Group, Breast Cancer Prevention, Division of Cancer Prevention, NCI, Rockville, Maryland
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