Provider Communication, Self-Reported Health, and Post-Treatment Regret among Young Breast Cancer Survivors
Objective: This research evaluates the relationship between breast cancer survivors' perceived communication with providers and their sense of control over their health, health behaviors, and health outcomes. In addition, the study examines the sociodemographic, health, and psychosocial characteristics of survivors that are associated with perceptions of provider communication. The project also addresses: (1) what women regret about their breast cancer treatment five years later, and (2) what characteristics of disease and treatment predict post-treatment regret.
Methods: Interviews were conducted with breast cancer survivors in the San Francisco Bay Area. Participants were interviewed following diagnosis. Five years later, women were asked whether they had any regrets about their cancer treatment (N=449) and participated in a longer interview (N=311). A subset of 5-year participants was available for a 10-year interview (N=311). Cross-sectional and longitudinal linear regression methods, as well as qualitative analysis and logistic regression were used to examine the questions of interest.
Results: Patients' perceptions of their communication with providers were not consistently associated with their sense of control over their health, their health behaviors, or health outcomes. When examining individual characteristics, problems with provider communication were associated with self-esteem (p<.05) and emotional support (p<.05), rather than with sociodemographic characteristics. Quantitative analysis of regret revealed that women who were anxious about the future (OR=1.32; p<.05) or had problems communicating with physicians (OR=1.26; p<.05) during treatment were more likely to express regret 5 years later. In addition, women with new or recurrent cancers 5 years later were significantly more likely to regret some aspect of their primary treatment (OR=5.81; p<.001).
Conclusion: This research supports the need to address the psychosocial aspects of cancer care in the survivorship phase and the need to improve study design in physician-patient communication research. Evidence is also provided for addressing the unique emotional needs of women with recurrent cancers, who may experience an undue burden of regret.