Study On Factors Affecting Surgical Decision-making Of Chinese Early-stage Breast Cancer Patient From Perspectives Of Both Doctors And Patients

ObjectivesBreast cancer is the commonest cause of cancer death in women worldwide.Currently,the main surgical methods of early-stage breast cancer(ESBC)include breast-conserving surgery(BCS)and mastectomy.Due to the advantages of beautiful appearance and safety after breast-conserving surgery,BCS has become the recommended surgical treatment for female early-stage breast cancer in the developed countries,while the level of BCS in China is relatively low.This study aims to analyze the related factors affecting surgical procedures for female patients with early-stage breast cancer,so as to provide evidence for the guidance of scientific surgical decision-making from the perspectives of both patient and surgeon.MethodsThe targeted patients were females diagnosed with early-stage breast cancer and received surgical treatment at Fujian Provincial Hospital from January 1,2015 to December 31,2019 were targeted.Clinical,demographic,and social-economic characteristics of the targeted patients were extracted from the hospital health information system.Relevant information of their attending surgeons was collected through smart-phone based self-respond online survey.On the basis of quantitative analysis,we conducted semi-structured interviews with 15 female ESBC patients after mastectomy,in order to deeply understand the decision-making process and the main reasons for patients accepting mastectomy.We first performed univariate analysis and then multivariate logistic regression to explore the associated factors with the probability of BCS decision-making.The surgery of patients(BCS=1,mastectomy=0)was taken as the dependent variable.The independent variable was the variable with a significant difference in univariate analysis(test level=0.15)and the variables to be included according to professional judgment.The interaction effect between surgeon and patient was fully considered.ResultsAmong the 566 patients who met the indications of BCS,140 patients took breastconserving surgery,and the appropriate BCS rate was 24.7%.The age of patient and attending surgeon,the economic development level of patient’s residence area were the associated factors with BCS decision making of female early-stage breast cancer.By controlling of the other factors unchanged,patients from middle-income areas were more likely to accept BCS(OR=1.91,95%CI:1.01～3.62)compared with those from low-income areas.Increasing of 1 year age of the attending surgeon and patient,will decrease 10%(95%CI:-19%～-1%,P=0.03)and 4%(95%CI:-7%～-1%,P=0.01)of the probability of BCS.The interaction effects of the age of attending surgeon and patient for some sample patients to choose BCS were statistically significant(Z>1.96,P<0.05),and the average interaction effect was 0.06%(Z=2.11,SE=0.03%,P<0.05).A total of 15 surgeons were investigated.Most surgeons took the initiative to inform the ESBC patients of the surgical treatment and postoperative treatment plan.Less attention did they pay to patients postoperative nursing,especially the psychological care.38.8%of the surveyed surgeons said that they would strongly recommend BCS to patients who met the indications of breast-conserving surgery.The top three factors influencing their implementation and recommendation of BCS were that "patients’ personal willingness to breast conserving is not strong","hospital frozen pathology technology is poor","patients care more about the cost of treatment".In patient interviews,many patients’ understandings of breast cancer and surgery was not completely correct;Many patients with ESBC did not value their aesthetic need,and some patients had not found their pursuit of body image before surgery;Almost all patients with mastectomy took "surgeon’s advice" and "avoiding cancer recurrence" as the main considerations of surgical decision-making,some patients will also consider personal health needs and treatment costs.Conclusions:To harmonize the optimal surgical treatment and the patient needs,and to improve the treatment of female early-stage breast cancer,the attending surgeon should continuously strengthen the study of evidence-based breast cancer surgery and enhance the skills,in order to play a more active role in assisting the patient in surgical decision-making.It is also essential for the attending surgeon to pay a close attention to the psychological reactions of female breast cancer patients in different ages,and to provide comprehensive information and education to patient before surgery.There is also a need to further enhance the benefit packages of patient entitled with the resident basic health medical insurance program,which will help to unblock the financial barrier of the patient in financial hardship to receive necessary BCS.