title: The relationship among physicians' specialty, perceptions of the risks and benefits of adjuvant tamoxifen therapy, and its recommendation in older patients with breast cancer.
abstract: OBJECTIVE
  The objectives of this study were to determine whether tamoxifen recommendation differs by physician specialty, to determine whether perception affects tamoxifen recommendation, and to investigate the association between the physician's specialty and the perception of risks and benefits of tamoxifen.
  
  
  METHODS
  We enrolled a cohort of geographically diverse women aged 65 and older with stage I through IIIa breast cancer in a prospective cohort study. We recruited their surgeons and, when applicable, their medical oncologists to provide patient-specific information about their perceptions of the risks and benefits of tamoxifen and whether they recommended tamoxifen. Each physician also completed a questionnaire regarding his or her demographic and practice characteristics. Patient data were collected through medical record review and a patient interview 3 months after definitive breast cancer surgery.
  
  
  RESULTS
  We collected physician treatment recommendation forms for 585 women. Oncologists were 2.5 times more likely to recommend tamoxifen, compared with surgeons, after adjusting for patient and tumor characteristics (95% confidence interval, 1.5-4.2). For both specialties, their perceptions of the risks and benefits of tamoxifen were strong predictors of tamoxifen recommendation. However, there were differences in perception by physician specialty. Distant metastases and tolerance of tamoxifen side effects were more important to oncologists, whereas local recurrence and risk of cataracts were more important to surgeons.
  
  
  CONCLUSIONS
  Physicians' perceptions of the risks and benefits of tamoxifen therapy for older women are important in their decision-making process.
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts 02118, USA. karim.malek@bmc.org
authors.forename: Karim
authors.initials: K
authors.lastname: Malek
authors.forename: Aliza K
authors.initials: AK
authors.lastname: Fink
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Thwin
authors.forename: Jerry
authors.initials: J
authors.lastname: Gurwitz
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D013038:Specialization; D013629:Tamoxifen / Q000627:therapeutic use*; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen