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Freedman RA, Ko NY, Lederman RI, Gagnon H, Fikre T, Gundersen DA, Revette AC, Odai-Afotey A, Kantor O, Hershman DL, Crew KD, Keating NL. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res Treat 2022; 196:623-633. [PMID: 36220997 PMCID: PMC9552717 DOI: 10.1007/s10549-022-06752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
Purpose The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care. Methods We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013–2017 and received care at one of three centers in Boston, MA, and New York, NY. We examined knowledge of breast cancer and treatment rationales, information preferences, and treatment receipt. Results During 2018–2020, we interviewed 313 women (American Association for Public Opinion Research Cooperation Rates 58.4–76.5% across centers) who were 56.9% White, 23.6% Black, 14.1% Hispanic, and 5.4% other. Among the 296 included in analyses, we observed high variability in knowledge of breast cancer and treatment rationales, with a substantial number demonstrating limited knowledge despite feeling highly informed; > 25% actively avoided information. Black and Hispanic (vs. White) women consistently knew less about their cancers. Lack of understanding of treatment rationales for chemotherapy, radiation, and hormonal therapy was common but not consistently different by race and ethnicity. Understanding treatment rationale (but not cancer knowledge) was associated with treatment initiation, but small sample sizes limited in-depth examination. Conclusions Our study highlights the need for enhanced informational support for breast cancer survivors, who are challenged with complex information during the decision-making process and beyond. More research is needed to understand how to further educate and empower diverse populations of patients with breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06752-8.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olga Kantor
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Rytwinski NK, Rosoff CB, Feeny NC, Zoellner LA. Are PTSD treatment choices and treatment beliefs related to depression symptoms and depression-relevant treatment rationales? Behav Res Ther 2014; 61:96-104. [PMID: 25151916 DOI: 10.1016/j.brat.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
Given high rates of depression and low rates of treatment utilization among individuals with posttraumatic stress disorder (PTSD), we examined how depression symptoms impact PTSD treatment beliefs and preference (prolonged exposure (PE), sertraline, or PE plus sertraline). We also examined whether PTSD treatment rationales tailored to individuals with symptoms of depression impact PTSD treatment preference/beliefs. Undergraduates (N = 439) were given an "imagine self" scenario where they either had symptoms of PTSD or PTSD and depression in the future. Trauma-exposed community members (N = 203) reported their own PTSD and depression symptoms. All participants watched standardized treatment rationales for PE and sertraline that were systematically manipulated to include information on depression or not. Across both samples, depression symptoms were associated with significantly increased odds of selecting combination treatment relative to PE alone. For those in the community sample who received the depression-relevant treatment rationale, higher depression symptoms were associated with significantly greater PE credibility and more positive reactions toward PE. Taken together, depression may be associated with a greater preference for combination treatment. However, treatment providers may be able to improve treatment beliefs about PE by offering a treatment rationale that explains that PE tends to help improve symptoms of PTSD and depression.
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Affiliation(s)
- Nina K Rytwinski
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | - Cari B Rosoff
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | - Norah C Feeny
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Lori A Zoellner
- University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA
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