Health care professional’s recommendation important factor for chemoprevention decisions
Bottom Line: A health care professional's recommendation was the most important factor driving decisions by women at high risk for breast cancer on whether to take selective estrogen receptor modulators (SERMs).
Journal in Which the Study was Published: Cancer Prevention Research, a journal of the American Association for Cancer Research.
Author: Lead investigator: 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, Berlin, Germany. co-primary investigator: Angela Fagerlin, PhD. Fagerlin was co-director, Center for Bioethics and Social Sciences in Medicine at the University of Michigan and the VA Ann Arbor Center for Clinical Management, where the research took place, and is now chair of the Department of Population Health Sciences at the University of Utah School of Medicine.
Background: Breast cancer is the most common cancer among women worldwide and in the United States. Two FDA-approved SERMs, tamoxifen and raloxifene, have demonstrated they can reduce breast cancer risk by up to 50 percent in prevention clinical trials, but low adoption of SERM use continues to be an issue, Holmberg explained.
How the Study Was Conducted: In a study to quantify the factors influencing SERM use among women at high risk for breast cancer, the researchers surveyed 1,023 American women in community care settings.
Study participants were asked to complete a survey at two time points: immediately after the counseling session with a health care professional, and then after they decided to take a SERM or not. The surveys examined topics discussed by health care professionals, including the range of treatment options for risk reduction, the risks and benefits of SERMs, and whether the information was conveyed by numbers or words. The researchers also collected patients' input on a range of social, cultural, and psychological factors.
Results: Of the 726 women who made a decision, 324 (44.6 percent) decided to take a SERM and 402 (55.4 percent) decided not to. The health care professional's recommendation played a statistically significant role and was the most important factor influencing the decision. Other associated factors included attitudes about taking medication, worry about developing breast cancer, trust in the health care professional, having a family member with blood clotting issues, and knowledge about the experiences of others who had taken SERMs. Menopausal status was not a determining factor.
Author Comment: "We were surprised how clear-cut our findings were. The health care professional's recommendation to take a SERM was paramount. None of the other characteristics related to the counseling session came close in importance," said Holmberg. "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."
"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 added. "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."
Limitations: The main limitation of the study was that the researchers did not verify actual SERM use or adherence to a regimen by women who reported they had decided to take a SERM. Further, the large number of women indicating an interest in SERM use may reflect that they were already in clinical care for breast cancer risk.
Funding & Disclosures: The Decision-Making Project-1 study was conducted by the former National Surgical Adjuvant Breast and Bowel Project, a clinical trials cooperative group now known as NRG Oncology, a member of the National Cancer Institute (NCI) National Clinical Trials Network. The study was sponsored by the National Institutes of Health. Holmberg declares no conflicts of interest.
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