Family influences breast cancer treatment among older Hispanics

The influence of the family in the treatment decision-making process for breast cancer may account the significant racial differences in breast cancer management, according to a new study. Published in the February 15, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that older, Hispanic women more than any other racial group, rely on family to make treatment decisions. Perhaps most important, patients who identified the family as the final treatment decision-maker were more likely to be treated with mastectomy rather than breast conserving surgery (BCS).

Previous studies have revealed racial and ethnic disparities in the treatment of breast cancer. For example, African-American and Hispanic women are less likely to receive BCS compared to whites, and more likely to die from their cancer than white women. The roots of these disparities may lie in socioeconomic or tumor-specific factors, but little is known about the contribution of physician-patient communication to treatment decisions and its impact on cancer management.

Rose C. Maly, M.D., M.S.P.H. and colleagues from the David Geffen School of Medicine at the University of California at Los Angeles interviewed 257 breast cancer patients aged 55 and above within three to nine months of their diagnosis. The objective of their study was to identify racial and ethnic differences in physician-patient communication and their impact on the treatment received.

The researchers found that Hispanic women were significantly more likely to identify a family member as the final decision-maker for treatment than were African-Americans and whites, regardless of their acculturation to American society. About a quarter of African-Americans and whites identified the physician as the final decision-maker compared to just 10 percent of Hispanics. Women who identified a family member as the final decision-maker were also less likely to receive BCS than mastectomy.

"The study's findings that families may actually make the final breast cancer treatment decision, particularly in older Latinas regardless of acculturation, is an important new contribution to the literature on cancer decision-making," the authors conclude. Because Hispanics are the fastest growing and second largest ethnic group in the United States, they write, "the study results are of relevance to a growing number of cancer care providers." They further suggest that, in this population, "physicians should acknowledge patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support."

Article: "Racial/Ethnic Group Differences in Treatment Decision-Making and Treatment Received among Older Breast Carcinoma Patients," Rose C. Maly, Yoshiko Umezawa, Carl T. Ratliff, Barbara Leake, CANCER; Published Online: January 9, 2006 (DOI: 10.1002/cncr.21680); Print Issue Date: February 15, 2006.

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