TY - JOUR
T1 - Healthcare system distrust, physician trust, and patient discordance with adjuvant breast cancer treatment recommendations
AU - Dean, Lorraine T.
AU - Moss, Shadiya L.
AU - McCarthy, Anne Marie
AU - Armstrong, Katrina
N1 - Funding Information:
L.T. Dean was supported by the NCI grant K01CA184288, the Sidney Kimmel Cancer Center grant P30CA006973, Johns Hopkins University Center for AIDS research grant P30AI094189, and National Institute of Mental Health grant R25MH083620. S.L. Moss was supported by the NIH grant R25GM062454 and the National Institute of Drug Abuse grant T32DA031099. This work was supported by the NIH grant from the NCI (5-R01-CA133004-3).
Funding Information:
L.T. Dean was supported by the NCI grant K01CA184288, the Sidney Kimmel Cancer Center grant P30CA006973, Johns Hopkins University Center for AIDS research grant P30AI094189, and National Institute of Mental Health grant R25MH083620. S.L. Moss was supported by the NIH grant R25GM062454 and the National Institute of Drug Abuse grant T32DA031099. This work was supported by the NIH grant from the NCI (5-R01-CA133004-3). The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System under contract with the Florida Department of Health (Project N.: BE0910). The Bureau of Health Statistics & Registries, Pennsylvania Department of Health has also provided data for this study (Project N.: IF-0317).
Publisher Copyright:
©2017 AACR.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust. Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust. Results: Of the 2,754 participants, 30.2% (n ¼ 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance. Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer. Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance.
AB - Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust. Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust. Results: Of the 2,754 participants, 30.2% (n ¼ 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance. Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer. Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance.
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U2 - 10.1158/1055-9965.EPI-17-0479
DO - 10.1158/1055-9965.EPI-17-0479
M3 - Article
C2 - 28971987
AN - SCOPUS:85036635122
SN - 1055-9965
VL - 26
SP - 1745
EP - 1752
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 12
ER -