Date of Award

1-1-2023

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anees B. Chagpar

Abstract

Background: Rates of contralateral prophylactic mastectomy (CPM) are increasing despite falling rates of contralateral breast cancer and controversy over survival benefit of the procedure. We investigated why and how patients choose to undergo CPM, with focus on the roles of financial burden, decision-making resources, and active participation in decision-making.

Methods:Female unilateral breast cancer patients older than 18 years old who had undergone mastectomy (with or without CPM) coming in to the Yale Breast Center for a follow-up or post-operative visit between June and August 2017 were approached with an opportunity to participate in this survey study. Chart review was completed for each patient to collect clinicopathologic data. The survey included both author-generated questions as well as the validated Satisfaction With Decision survey and Functional Assessment of Cancer Therapy – Breast, a quality of life survey.

Results:109 eligible patients were approached, and 101 completed the survey (response rate 93%). 55 CPM patients (54.5%) and 46 unilateral mastectomy (UM) patients (45.5%) were included in this study. Both CPM and UM patients were highly satisfied with their respective decisions, with mean Satisfaction With Decision (SWD) scores of 4.72 and 4.85, respectively, out of 5.00 where 5.00 is the highest possible satisfaction (p=0.078). CPM patients were found on bivariate analysis to more often anticipate a “very large” financial burden compared with UM patients (25.5% vs. 8.7%, p=0.037), but the effect was dampened upon multivariate analysis controlling for other factors associated with financial burden and CPM (OR 3.65, 95% CI 0.848-15.698, p=0.082). CPM and UM patients had similar rates of reporting anticipated financial burden at least somewhat affecting surgical decision (19.6% vs. 12.7%, p=0.417). There was no association between actual financial burden and satisfaction or QoL across both CPM and UM patients (p>0.05). Use of cancer patients’ experiences was independently associated with above average satisfaction (OR 9.40, 95% CI 1.01-87.58, p=0.049). Those who reported engaging in active participation in decision-making more often chose CPM compared with those who received a recommendation from their surgeon (68.3% vs. 30.8%, p

Conclusion:CPM patients were just as satisfied with their surgical decision as were UM patients, and both groups reported similar rates of having anticipated financial burden affecting surgical decision-making. Use of other cancer patients’ experiences while choosing between CPM and UM predicted higher satisfaction. Patients who engaged in active participation in decision-making tended to undergo CPM, with the majority of all patients preferring to take an active role with their surgeon in considering CPM vs. UM.

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This is an Open Access Thesis.

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