gms | German Medical Science

Introduction: Numerous studies have presented that patients with breast cancer (BC) can not be appropriate informed partners for decision making. They receive insufficient information about benefit of therapies and inaccurate estimations of risks. A pilot project was performed to survey the subjective estimation of the necessary benefit of therapeutic options.

Material and methods: Questions survey the individual estimation of the necessary benefit of chemotherapy (CT), endocrine therapy (ET), radiotherapy (RT) and complementary medicine in the curable and palliative setting on the basis of 18 clinical examples. Physicians were asked about their professional experience. The questionnaire was given to 50 women with BC and to 100 physicians supported by the Förderverein Tumorzentrum Erlangen-Nürnberg e.V. Primary end points were the evaluation of understandability and conclusiveness.

Results: 48 patients (96%) and 23 physicians (23.0%) have answered the questionnaire. 12.5% of the patients already had a relapse and 8.3% an advanced BC. 12.5% had CT prior surgery and 47.9% after surgery. 93.8% had RT and 58.3% had ET.

Only 41.7% of the patients would choose CT, if 5-year-survival is 60% without CT and improve of survival is ≤10%. 55% of the patients needed a benefit of ≥20%. 77.3% of the physicians would choose CT, if the benefit is ≤10% [p=0.003]. Just 13.5% of them need a benefit of ≥20%. 37.5% of the patients would choose ET with a benefit of ≤5% [physicians 77.3%; p<0.001]. 54.3% would use RT, if risk of relapse is 60% and the risk reduction is ≤5%. Physicians had the same views [52.4%; p=0,008].

In the palliative setting, 18.4% of all patients, but 47.7% of the physicians, would choose CT with a life prolongation of six months, if they have a life expectancy of six months (p=0.003). 44.7% of the patients (no physician) would not use CT until life prolongation is ≥5 years. The mean value of understandability of the questionnaire was 8.28 (7.73-8.95) for patients and 8.72 (8.10-9.48) for physicians on a scale between one and ten (perfect understanding).

Conclusion: The analysis proved an understandable and conclusive questionnaire. First results presented statistical significant differences between both groups. Following, the survey will be send to 10.000 women with BC and to 2.000 physicians. End point is the development of a tool for patient orientated decision making. BC support groups were asked for support of the coming study. 460 stated their support.