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Understanding Patient Trade-Offs When Choosing Between Breast Conservation Surgery (BCS) and Mastectomy Study

Allan Gabriel, MD, PeaceHealth Plastic Surgery and Toni Storm-Dickerson, MD, Compass Oncology, Vancouver, WA; Matthew Gitlin, PharmD, Jorge Farias, PharmD, and Lopa Das, MPH, MPhil, BluePath Solutions, Inc, Santa Monica, CA; and David Macarios, MBA, MSc
Study abstract

OBJECTIVES: The primary objective will be to understand the relative importance among specific patient-level factors in making a surgical treatment decision.

METHODS: Web based survey using adaptive conjoint design using a convenience sample of healthy women and women with breast cancer from the Army of Women research database. The survey will contain three types of question sets: 1) patient information such as their demographics and characteristics, 2) attitudes and beliefs towards cancer, breast cancer, and treatment, and 3) surgical treatment choice in a conjoint analysis to elicit preferences for various clinical, economic, and humanistic factors that may explain the decision to undergo BCS or mastectomy. The conjoint analysis will employ discrete choice modeling (Multinomial or Mixed logit) to calculate part-worth utilities assigned to factors that trigger choice of mastectomies in breast cancer patients. This will provide insight into the rank order of different clinical, humanistic, and economic factors and variations in patient preferences.

EXPECTED RESULTS: The research team expects that aesthetic factors (i.e. reconstruction, breast symmetry, nipple preservation) will be valued as highly and sometimes greater than the clinical factors (i.e. overall survival, local recurrence) and will be major driving factors for patient “choice” when selecting between BCS or mastectomy. The research team also anticipates that the cost associated with surgery will be another major driver of “choice”.

Study review

The purpose of the Understanding Patient Trade-Offs When Choosing Between Breast Conservation Surgery (BCS) and Mastectomy Study is to learn what is most important to women when they are faced with deciding between a mastectomy (with or without reconstructive surgery) or lumpectomy with radiation. This information may help physicians learn how to better communicate surgical options to patients. It will also help the researchers develop educational materials to assist women as they are making their surgical decision.