Communication can ease patient worries about DCIS

2020 01 31 00 31 5708 Doctor Woman Patient Older 400

Radiologists can improve communication with patients to ease worries and reduce confusion for women diagnosed with ductal carcinoma in situ (DCIS), according to a study of over 1,800 women published February 22 in Cancer.

A team led by Shoshana Rosenberg from Cornell University found that many women with a history of DCIS reported confusion and concern about their diagnosis and treatment.

"Our findings support the need for attention and intervention to address these issues from all providers who care for women with DCIS," Rosenberg told AuntMinnie.com.

Nearly 50,000 women each year in the U.S. are diagnosed with DCIS. While there is a low likelihood that DCIS lesions will spread to become invasive breast cancers, some combination of surgery, radiation, or endocrine therapy is used to treat lesions.

But overdiagnosis is a concern among researchers when it comes to treating DCIS. Recent studies have pointed to surveillance strategies over surgery to help with this.

The Rosenberg team wrote that the ambiguity around DCIS and treatment strategies "underscores the importance of patients fully understanding" their diagnosis and treatment option risks.

The researchers wanted to look at the experience of women with DCIS regarding their diagnosis, treatment, and survivorship care through a survey. Their goal was to better understand the women's concerns through these stages.

"Understanding both the clinical and psychosocial impacts of a DCIS diagnosis from the patient's perspective can identify knowledge gaps, opportunities for improved communication, and unmet supportive care needs," the study authors wrote.

A total of 1,832 women with a median diagnosis age of 60 responded to the survey. Rosenberg and colleagues identified four themes from the women's responses, including the following:

  • Uncertainty surrounding a DCIS diagnosis
  • Uncertainty about DCIS treatment
  • Concern about treatment side effects
  • Concern about recurrence and/or developing invasive breast cancer

The researchers wrote that "many" women reported having a lack of understanding and support, such as their physicians minimizing their DCIS diagnosis or failing to recognize its impact. In fact, 1,423 women reported being uncertain about whether DCIS was cancer or not.

Other points of uncertainty reported by the women included whether they should be considered a "survivor" or what the appropriate amount of treatment was. They also expressed concern about the possibility of cancer spreading or preventing recurrence.

So, what can radiologists do to help ease their patients' worries? Rosenberg said they can be equipped with better tools to help communicate information about DCIS. These include talking about the harms and benefits of different management options, as well as accurate information around risk of recurrence and risk of invasive breast cancer is one strategy.

Rosenberg also said tools such as decision aids can help support shared decision-making around treatment by providing patients with balanced information about the harms and benefits of different management options while considering personal preferences and values.

"I think this approach can help with the uncertainty many patients experience and better support patients following their diagnosis when they are considering their treatment options," she told AuntMinnie.com.

The team wrote that data from ongoing trials could inform radiologists and healthcare providers on the impact of different management strategies, such as active monitoring versus surgery, for low-risk DCIS on both disease and quality-of-life outcomes.

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