Annals of Oncology Advance Access originally published online on June 1, 2009
Annals of Oncology 2009 20(10):1647-1652; doi:10.1093/annonc/mdp057
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breast cancer |
Discussion about switch strategy in the adjuvant hormonal therapy of breast cancer: psychological aspects of physician–patient communication
1 Psychoncology Unit, Department of Oncology, Sant'Andrea Hospital, Sapienza University of Rome
2 Mental Health Unit, Center of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome
3 Department of Oncology and Neurosciences, Inter-University Consortium for Bio-Oncology "G. D'Annunzio", Chieti-Pescara
4 Clinical and Oncological Psychology, University of Turin, Turin
5 Medical Oncology Unit, Department of Oncology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
6 Departments of Behavioral Science and Faculty Development, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
* Correspondence to: Prof. S. Iacobelli, "G. D'Annunzio" University Medical School, Via dei Vestini, 66100 Chieti, Italy. Tel: +39-0871-3556732; Fax: +39-0871-3556707; E-mail: iacobell{at}unich.it
Background: A survey of oncologists was conducted in Italy to evaluate the potential problems of physician–patient discussion about hormonal switch in the adjuvant therapy of breast cancer.
Materials and methods: A questionnaire, including both closed and open-ended questions, was administered to 70 oncologists. Fifty-one of them returned completely filled questionnaires.
Results: Forty-seven percent of the physicians reported difficulties in proposing the hormonal switch, and 60% stated that they found it difficult to make the therapeutic change acceptable to patients. The oncologist's barriers to propose the switch were related mostly to scientific and economic issues, such as the lack of certain advantages of aromatase inhibitors over tamoxifen (28%), their costs (14%) and their side-effects (34%). On the other hand, according to physicians, the patient's barriers to accept the therapeutic change were mainly due to psychological–relational factors, in particular the anxiety produced by the change (40%) and the bad patient–physician communication experienced in the past (26%).
Conclusions: Patient–physician communication difficulties about switch strategy in the adjuvant hormonal treatment of breast cancer are, at least in part, related to psychological and relational factors. It is likely that training programs, improving doctor's communication skills, can overcome these problems.
Key words: breast cancer, hormonal switch, patient anxiety, physician–patient communication, recurrence risk
Received for publication February 4, 2009. Revision received February 9, 2009. Accepted for publication February 11, 2009.