title: Discussion of treatment options for early-stage breast cancer: effect of provider specialty on type of surgery and satisfaction.
abstract: OBJECTIVE
  To describe the physicians with whom breast cancer patients discuss treatment options and assess whether discussing surgical options with a medical oncologist is associated with type of surgery and satisfaction.
  
  
  METHODS
  Medical record abstraction and survey.
  
  
  METHODS
  Women with early-stage breast cancer numbering 2,426 in two states-Massachusetts, where the rate of breast-conserving surgery is high, and Minnesota, where it is lower.
  
  
  METHODS
  Receipt of breast-conserving surgery and satisfaction.
  
  
  RESULTS
  Women in Massachusetts discussed breast cancer treatments with more physicians than women in Minnesota (mean 3.5 vs. 2.8; P <0.001) and more often discussed surgical options with a medical oncologist (52% vs. 28%; P <0.001). Using propensity score analyses, in Massachusetts, discussing surgical options with a medical oncologist was not related to type of surgery (adjusted difference in rate of breast-conserving surgery: 3.9%, 95% CI -3.6% to 11.5%) but was associated with greater satisfaction (adjusted difference: 8.1, 95% CI 2.0% to 14.2%). In Minnesota, discussing surgical options with a medical oncologist was associated with breast-conserving surgery (adjusted difference: 12.6%, 95% CI 5.6% to 19.7%) with no difference in satisfaction (adjusted difference: -1.5%, 95% CI -6.8% to 3.8%).
  
  
  CONCLUSIONS
  Outcomes associated with discussing surgical treatments with a medical oncologist vary with local care patterns. Where breast-conserving surgery is standard care, seeing a medical oncologist is not related to type of surgery, but is associated with greater satisfaction. Where it is not the standard, seeing a medical oncologist is associated with more breast-conserving surgery and equivalent satisfaction. These findings suggest that collaborative care may benefit women with respect to treatment selection or satisfaction.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
authors.forename: N L
authors.initials: NL
authors.lastname: Keating
authors.forename: J C
authors.initials: JC
authors.lastname: Weeks
authors.forename: M B
authors.initials: MB
authors.lastname: Landrum
authors.forename: C
authors.initials: C
authors.lastname: Borbas
authors.forename: E
authors.initials: E
authors.lastname: Guadagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D003625:Data Collection; D005260:Female; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008495:Medical Oncology; D008511:Medicine; D008875:Middle Aged; D008910:Minnesota; D010358:Patient Participation; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013038:Specialization; D018709:Statistics, Nonparametric