Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand

Roder, David M., de Silva, Primali, Zorbas, Helen N., Webster, Fleur, Kollias, James, Pyke, Chris M. and Campbell, Ian D. (2012) Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand. Asian Pacific Journal of Cancer Prevention, 13 4: 1675-1682.


Author Roder, David M.
de Silva, Primali
Zorbas, Helen N.
Webster, Fleur
Kollias, James
Pyke, Chris M.
Campbell, Ian D.
Title Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand
Journal name Asian Pacific Journal of Cancer Prevention  (ERA 2012 Listed)    (ERA 2010 Rank C)   Check publisher's open access policy
Publication date 2012-01
Sub-type Article
DOI 10.7314/APJCP.2012.13.4.1675
Volume number 13
Issue number 4
ISSN 1513-7368
Start page 1675
End page 1682
Total pages 8
Place of publication Bangkok, Thailand
Publisher Asian Pacific Organization for Cancer Prevention
Collection year 2013
Language eng
Formatted abstract Aim: The study aim was to determine the frequency with which women decline clinicians’ treatment
recommendations and variations in this frequency by age, cancer and service descriptors. Design: The study
included 36,775 women diagnosed with early invasive breast cancer in 1998-2005 and attending Australian and
New Zealand breast surgeons. Rate ratios for declining treatment were examined by descriptor, using bilateral
and multiple logistic regression analyses. Proportional hazards regression was used in exploratory analyses of
associations with breast cancer death. Results: 3.4% of women declined a recommended treatment of some
type, ranging from 2.6% for women under 40 years to 5.8% for those aged 80 years or more, and with parallel
increases by age presenting for declining radiotherapy (p<0.001) and axillary surgery (p=0.006). Multiple
regression confirmed that common predictors of declining various treatments included low surgeon case load,
treatment outside major city centres, and older age. Histological features suggesting a favourable prognosis
were often predictive of declining various treatments, although reverse findings also applied with women with
positive nodal status being more likely to decline a mastectomy and those with larger tumours more likely to
decline chemotherapy. While survival analyses lacked statistical power due to small numbers, higher risks
of breast cancer death were suggested, after adjusting for age and conventional clinical risk factors, (1) for
women not receiving breast surgery for unstated reasons (RR=2.29; p<0.001); and (2) although not approaching
statistical significance p≥ 0.200), for women declining radiotherapy (RR=1.22), a systemic therapy (RR1.11),
and more specifically, chemotherapy (RR=1.41). Conclusions: Women have the right to choose their treatments
but reasons for declining recommendations require further study to ensure that choices are well informed and
clinical outcomes are optimized.
Keyword Early breast cancer
Declining treatment
Survival
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article
Collections: Official 2013 Collection
School of Medicine Publications
 
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