University Breast Center for Franconia, Department of Gynaecology and Obstetrics, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, Erlangen-Nuremberg 91054, Germany.
Breast Cancer Res Treat. 2012 Oct;135(3):811-20. doi: 10.1007/s10549-012-2218-y. Epub 2012 Aug 30.
Several factors can influence individual perceptions of the expected benefit of recommended adjuvant treatment for breast cancer. This study investigated differences between patients and physicians with regard to the required efficacy of treatment and the factors influencing patients' and physicians' willingness to accept different therapeutic options. A total of 9,000 questionnaires were distributed to patients with breast cancer, and 6,938 questionnaires were distributed to physicians treating breast cancer patients. The patients were asked for personal information and about their medical history and experiences during treatment. The physicians were asked about personal information and their specialty and work environment. The treatment efficacy required by the two groups was assessed using six virtual cases of breast cancer and the treatment regimens proposed, with specific benefits and side effects. A total of 2,155 patients and 527 physicians responded to the questionnaire (return rates of 23.9 and 7.6 %). Significantly different ratings between patients and physicians with regard to the expected benefit of certain treatment options were observed. The differences were noted not only for chemotherapy but also for antihormonal and antibody treatments. Whereas physicians had a quite realistic view of the expected treatment benefits, the patients' expectations were varied. Approximately one-fifth of the patients were willing to accept treatment regimens even with marginal anticipated benefits, whereas one-third required unrealistic treatment benefits. Several influencing factors that were significantly associated with the quality rating of treatment regimens in the groups of breast cancer patients and physicians were also identified. In contrast to physicians, many breast cancer patients required treatment benefits beyond what was realistically possible, although a large group of patients were also satisfied with minimal benefits. Individual factors were also identified in both groups that significantly influence thresholds for accepting adjuvant treatment, independently of risk estimates and therapy guidelines.
有几个因素可能会影响个人对推荐的乳腺癌辅助治疗预期获益的看法。本研究调查了患者和医生在治疗效果要求方面的差异，以及影响患者和医生接受不同治疗方案意愿的因素。共向乳腺癌患者发放了 9000 份问卷，向治疗乳腺癌患者的医生发放了 6938 份问卷。患者被要求提供个人信息以及他们的病史和治疗经历。医生被要求提供个人信息以及他们的专业和工作环境。使用 6 个虚拟乳腺癌病例和提出的治疗方案，评估了两组患者所需的治疗效果，具体包括获益和副作用。共有 2155 名患者和 527 名医生对问卷做出了回应（回应率分别为 23.9%和 7.6%）。观察到患者和医生对某些治疗方案预期获益的评价存在显著差异。这种差异不仅在化疗中存在，在抗激素和抗体治疗中也存在。虽然医生对预期治疗获益的看法相当现实，但患者的期望则各不相同。大约五分之一的患者愿意接受即使获益有限的治疗方案，而三分之一的患者则要求不切实际的治疗获益。还确定了几个与乳腺癌患者和医生治疗方案质量评分显著相关的影响因素。与医生不同的是，许多乳腺癌患者需要的治疗获益超出了现实可能的范围，尽管也有很大一部分患者对最小的获益感到满意。两组患者中还确定了一些个体因素，这些因素独立于风险估计和治疗指南，显著影响了接受辅助治疗的门槛。
