CHARACTERIZING SURGICAL TREATMENT DECISION INVOLVEMENT IN YOUNG WOMEN WITH BREAST CANCER

Purpose: Little is known about how young women make treatment decisions; a better understanding of these factors can potentially inform and improve the decision-making process. We sought to evaluate socio-demographic, clinical, and psychological factors in relation to surgical decisional involvement in very young women with breast cancer.

Method: As part of an ongoing multi-center cohort study enrolling women diagnosed with breast cancer at age ≤ 40, we evaluated 470 women with Stage 0-III disease. Women self-reported whether their final decision about surgical treatment was mainly their own, shared with their doctor, or mainly their doctor’s. Multinomial logistic regression models were fit to assess factors associated with: 1) patient-driven vs. shared decisions; 2) physician-driven vs. shared decisions. Independent variables with a p-value ≤ 0.15 in bi-variate analyses were included in the final multivariable model.

Result: Median age at diagnosis was 37 (range: 17-40). Most women had stage I or II disease (82%), and estrogen receptor (ER) positive tumors (70%).  42% of women reported the decision about surgery was their own, 49% reported the decision was shared, and 9% reported the decision was mainly their physician’s. Most women (452/470) were satisfied with their involvement in the decision, with only 3% indicating they would have preferred more involvement. In the multivariable analysis (Table 1), depressed women were less likely, while women who had bilateral mastectomies more likely, to report patient-driven decisions. Minority women were more likely, and women with bilateral mastectomies less likely, to report a physician-driven decision. Age at diagnosis, tumor size, nodal status, marital status, parity, radiation treatment, having a cancer-predisposing mutation, family history, and anxiety were not significantly associated with decisional involvement.

Conclusion: Our findings suggest that certain patient and clinical characteristics are associated with surgical decisional involvement in young women with breast cancer. These factors should be considered in an effort to promote quality decision-making while enhancing communication about these decisions between physicians and patients. 

Table 1. Multivariable analysis of factors associated with decisional involvement

	Patient vs. Shared	Physician vs. Shared
	OR (95% CI)	OR (95% CI)
Depression	0.40 (0.17-0.95)	2.18 (0.81-5.89)
Tumor size	1.27 (0.81-1.94)	1.49 (0.72-3.08)
Non-White non-Hispanic	1.43 (0.74-2.78)	2.73 (1.14-6.50)
Radiation	0.76 (0.46-1.25)	1.72 (0.69-4.28)
Surgery (ref=lumpectomy)
Bilateral mastectomy	2.22 (1.26-3.93)	0.23 (0.06-0.89)
Unilateral mastectomy	0.80 (0.43-1.48)	1.88 (0.80-4.38)