Risk Info for Breast Cancer Patients Too Confusing

FRIDAY Dec. 12, 2008 -- Information patients commonly receive about the risk of their breast cancer returning after surgery may make their decision on whether to get chemotherapy more difficult, a new study concludes.

Doctors typically show breast cancer patients a bar chart, based on a standard risk-assessment tool, with four different post-surgery choices: hormonal therapy alone, chemotherapy alone, hormonal therapy and chemotherapy combined, or no treatment at all. In a study, published in the December issue of Cancer, just a little more than half of 1,619 women shown the same graph correctly understood which choice would best increase their chance of survival.

"The main benefit of additional treatments such as chemotherapy after surgery is long-term risk reduction. But chemotherapy does not provide much benefit for some women, and those women can potentially avoid unnecessary side effects by skipping chemotherapy," study author Brian Zikmund-Fisher, a research assistant professor of general medicine at the University of Michigan Medical School, said in an university news release. "So understanding how large or small the risk reduction is can help women make the right choice."

The problem is there are too many choices, he said. Hormonal treatments greatly help women whose cancers are sensitive to estrogen. For these patients, the real question is whether they should add chemotherapy; but for most other patients, the choice is only chemo or no chemo.

In the study, the women -- who were given hypothetical breast cancer diagnoses -- viewed several graphics, each showing how chemotherapy would reduce the risk of dying from a return of cancer. When shown a simpler graph than showed only the two key options, rather the traditional four, 65 percent correctly found the value of chemotherapy. When the simpler graph was changed to pictograph of 100 small rectangles representing the possible outcomes, 77 percent of the women correctly reported the benefit of chemotherapy.

"Even when patients are given the information they need, they have to be able to understand it well enough to make the right choice. We're making patients work too hard. Discussions of risk need to be simple and transparent so doctors can spend as little time as possible explaining the numbers to patients and as much time as possible talking about what those numbers mean," Zikmund-Fisher said.

More information

The U.S. National Cancer Institute has more about breast cancer treatments.

Posted: December 2008


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