A new study by researchers at Georgetown University Medical Center has found that care improves for older breast cancer patients if their doctors make an extra effort to improve communication about treatment options and other decisions.

Dr. Wenchi Liang and colleagues, writing in the Journal of Clinical Oncology, noted that older patients are less likely to seek medical information than younger patients. Therefore, patient/physician communication is especially important with this age group.

Liang's team surveyed 613 patients and their physicians about their overall level of communication. All of the patients were over 67 years of age and were being treated for localized breast cancer.

They found that the older women who reported having more communication with their physicians also reported that they were given more treatment choices. These women were also more likely to undergo breast-conserving surgery plus radiation compared to other treatments.

Interestingly, they found that the physicians most likely to initiate a strong communication relationship with their patients were surgical oncologists and those whose practice primarily included breast cancer patients (75 percent or more).

In addition, after a six-month follow-up period, they found that a high-degree of physician-initiated communication directly resulted in a high level of patient satisfaction with their care.

"Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care," they concluded. "Physicians may [therefore] need to play a more active role in raising older women's awareness of the advantages and disadvantages of various treatment options."

Other studies have shown that as many as three-quarters of the questions that cancer patients have are not asked during medical appointments. This is especially true for older patients. Fear of humiliation in front of the doctor is the most commonly cited reason, followed by a worry that the doctor will misunderstand her motivation for questioning, or think that she is second-guessing his or her judgment. Furthermore, patients sometimes feel urgency about the amount of time they are taking from their doctor's "needier" patients.

Nonetheless, all patients need to keep in mind that they are the one with cancer, and they are the one with the ultimate authority to make any treatment decisions. It may be helpful to bring a family member or friend along to any medical appointments, and to write down any questions you have beforehand-and make sure that they are asked during the appointment.

SOURCE:
Journal of Clinical Oncology, February 15, 2002; 20(4):1008-1016