Advantages seen when women with breast cancer join in selecting surgeon
NEW YORK (Reuters Health) - Women with breast cancer who are involved in the process of selecting a surgeon are more likely to be treated by more experienced surgeons and in hospitals with cancer programs, according to a report in the Jan. 20 issue of the Journal of Clinical Oncology.
Surgeon and hospital characteristics can influence the outcomes of cancer treatments, the authors explain, but little is known about the factors associated with referral pathways.
Dr. Steven J. Katz from the University of Michigan, Ann Arbor, and colleagues used survey data from women recently diagnosed with breast cancer and their attending surgeons to determine how surgeons are selected, and whether there is any association between that process and characteristics of the surgeon and hospital.
Most patients were referred to their surgeon by another doctor or by their health plan. In addition to that, they chose the surgeon for a number of reasons -- the surgeon's reputation, the institution's reputation, the recommendation of family or friends, or proximity.
"When we combined responses we found that 54.3% reported that they were referred but did not select their surgeon; one fifth (21.9%) reported that they were referred and they selected their surgeon; one fifth (20.3%) reported that they selected their surgeon but were not referred by a provider or plan," the investigators report. The remaining 4.9% had a prior relationship with their surgeon.
Women who selected their surgeon by reputation were more likely to be treated by a high-volume surgeon (odds ratio, 2.2) and in a National Cancer Institute-designated cancer center or other American College of Surgeons-approved programs (OR, 2.0), the team reports.
Patients who were referred by a doctor or health plan were less likely to be treated by a high-volume surgeon or in hospitals with approved cancer programs, the researchers note.
"More research is needed to address the quality implication of the referral patterns identified in this study," Katz and colleagues say. "In the meantime, women with breast cancer should be aware that provider-based referral might not connect them with the most experienced surgeons or the most comprehensive practice setting in their community."
They conclude, "Patients might consider a second opinion, especially if they are advised to undergo a particular procedure without a full discussion of treatment options or a clear medical rationale for the recommendation."
J Clin Oncol 2007;25:271-276.