Second Opinions from Medical Oncologists for Early-Stage Breast Cancer: Prevalence, Correlates and Consequences

Details

• Alternative Title:
  JAMA Oncol
• Personal Author:
  Kurian, Allison W. ; Friese, Christopher R. ; Bondarenko, Irina ; Jagsi, Reshma ; Li, Yun ; Hamilton, Ann S. ; Ward, Kevin C. ; Katz, Steven J.
• Description:
  Importance
  
  Advances in the evaluation and treatment of breast cancer have made the clinical decision-making context much more complex. A second medical oncology opinion may facilitate decision-making for women with breast cancer, yet little is known about second opinion use.
  
  Objective
  
  We investigated the patterns and correlates of second opinion use, and their impact on chemotherapy decisions.
  
  Design, Setting, and Participants
  
  A total of 1901 women newly diagnosed with stages 0 to II breast cancer between July 2013 and September 2014 (response rate, 71%), accrued through two population-based SEER registries (Georgia and Los Angeles County, California) and surveyed about their experiences with medical oncologists, decision-making, and chemotherapy use.
  
  Main Outcome Measures
  
  Factors associated with second opinion use were evaluated using logistic regression. Also assessed was the association between second opinion and chemotherapy use, adjusting for chemotherapy indication and propensity for receiving a second opinion. Multiple imputation and weighting were used to account for missing data.
  
  Results
  
  A total of 1,901 patients with stage I to II breast cancer (mean [SD] age, 61.6 [11.0]; 1071 [56.3%] non-Hispanic white) saw any medical oncologist. Analysis of multiply imputed, weighted data (mean n=1866) showed that 168 (9.8%) (SE, 0.74%) received a second opinion and 54 (3.2%) (SE, 0.47%) received chemotherapy from the second oncologist. Satisfaction with chemotherapy decision-making was high and did not differ between those who did (mean [SD], 4.3 [0.08] on a 1- to 5-point scale) or did not (4.4 [0.03]) obtain a second opinion (p=.29). Predictors of second opinion use included college education vs less education (odds ratio [OR], 1.85; 95% CI, 1.24–2.75), frequent use of internet-based support groups (OR, 2.15; CI, 1.12–4.11), an intermediate result on the 21-gene recurrence score assay (OR, 1.85; CI, 1.11–3.09), and a variant of uncertain significance on hereditary cancer genetic testing (OR, 3.24; CI, 1.09–9.59). After controlling for patient and tumor characteristics, second opinion use was not associated with chemotherapy receipt (OR, 1.04; 95% CI, 0.71–1.52).
  
  Conclusion and Relevance
  
  Second opinion use was low (<10%) among patietns with early-stage breast cancer, and high decision satisfaction regardless of second opinion use suggests little unmet demand. Along with educational level and use of internet support groups, uncertain results on genomic testing predicted second opinion use. Patient demand for second opinions may grow as increasingly complex genomic tests are disseminated.
  
  
• Subjects:
  Adult Aged Breast Neoplasms Decision Making Drug Therapy Female Genetic Testing Humans Logistic Models Medical Oncology Middle Aged Neoplasm Staging Patient Satisfaction Referral And Consultation SEER Program Young Adult

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• Source:
  JAMA Oncol. 3(3):391-397
• Pubmed ID:
  28033448
• Pubmed Central ID:
  PMC5520652
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201300015C/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; P01 CA163233/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  3
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7ee28fc2b1fc22b05a3cc4a9df41014fc790b0734295d9a3af9063784a0dc74e
• Download URL:
  https://stacks.cdc.gov/view/cdc/50376/cdc_50376_DS1.pdf
• File Type:
  [PDF - 565.83 KB ]