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Physician recommendation drives use of chemoprevention for breast cancer
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A health care provider’s recommendation served as the most important factor for deciding to use selective ER modulators among women at high risk for breast cancer, according to an analysis from the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project-1.
“We were surprised how clear-cut our findings were,” Christine Holmberg, PhD, MPH, head of the mixed-method studies in health services research and senior researcher and lecturer at the Institute of Public Health, Charité – Universitätsmedizin in Berlin, Germany, said in a press release. “The health care professional’s recommendation to take a selective ER modulator [SERM] was paramount. None of the other characteristics related to the counseling session came close in importance.
“We also found that the health care professional’s recommendation for taking a SERM was more likely to be followed by women with a positive attitude about taking medication,” she added.
Tamoxifen and raloxifene — two FDA-approved SERMs — have demonstrated up to a 50% reduction in breast cancer risk in prevention trials. Although a variety of decision aids exist that increase knowledge of the risks and benefits of chemoprevention, the use of SERMs remains low.
Researchers designed the study to improve understanding of the psychological, social and cultural factors that influence a woman’s decision-making regarding breast cancer chemoprevention.
The analysis included data from 1,023 American women (39.4% aged 49 years or younger; 88.3% white; 64.1% postmenopausal) from community care settings.
The women received surveys immediately after a counseling session with a health care professional, and then after they had made their decision regarding SERMs. The survey included questions about the topics discussed by health care professionals, the range of treatment options for risk reduction, the risks and benefits of SERMs, and whether the women received this information in numbers or words.
Of 726 women who reported that they made a decision, 324 (44.6%) decided to take a SERM and 402 (55.4%) decided against taking a SERM.
Women appeared much more likely to decide to take a SERM if their health care provider recommended doing so (OR = 14; 95% CI, 8.39-23.37). Women also appeared more likely to take a SERM if they thought of women who took them as brave, smart or taking good care of themselves (OR = 7.57; 95% CI, 3.41-16.78).
Other factors associated with SERM use included attitudes about taking medicine (OR = 1.05; 95% CI, 1.02-1.09), worry about breast cancer (a lot worried, OR = 3.61; 95% CI, 2.04-6.38), trust in their health care provider (OR = 1.06; 95% CI, 1.02-1.1), having a family member with blood clotting problems (OR = 0.59; 95% CI, 0.38-0.92), and knowing someone who took SERMs who had a good (OR = 2.06; 95% CI, 1.3-3.26) or bad experience (OR = 0.38; 95% CI, 0.22-0.64).
Researchers noted these data may be limited because they did not verify actual SERM use or adherence.
“Our research suggests that it is not enough to present medical facts and information about risks and benefits of SERMs to patients who have an increased risk for breast cancer,” Holmberg said. “Helping them find the prevention approach that is right for them is crucial. Health care professionals need to take patients’ attitudes, beliefs and experiences into account and make a recommendation, one way or the other.” – by Alexandra Todak
Disclosures: The authors report no relevant financial disclosures.
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