title: Discussion about switch strategy in the adjuvant hormonal therapy of breast cancer: psychological aspects of physician-patient communication.
abstract: BACKGROUND
  A survey of oncologists was conducted in Italy to evaluate the potential problems of physician-patient discussion about hormonal switch in the adjuvant therapy of breast cancer.
  
  
  METHODS
  A questionnaire, including both closed and open-ended questions, was administered to 70 oncologists. Fifty-one of them returned completely filled questionnaires.
  
  
  RESULTS
  Forty-seven percent of the physicians reported difficulties in proposing the hormonal switch, and 60% stated that they found it difficult to make the therapeutic change acceptable to patients. The oncologist's barriers to propose the switch were related mostly to scientific and economic issues, such as the lack of certain advantages of aromatase inhibitors over tamoxifen (28%), their costs (14%) and their side-effects (34%). On the other hand, according to physicians, the patient's barriers to accept the therapeutic change were mainly due to psychological-relational factors, in particular the anxiety produced by the change (40%) and the bad patient-physician communication experienced in the past (26%).
  
  
  CONCLUSIONS
  Patient-physician communication difficulties about switch strategy in the adjuvant hormonal treatment of breast cancer are, at least in part, related to psychological and relational factors. It is likely that training programs, improving doctor's communication skills, can overcome these problems.
authors.affiliation: Psychoncology Unit, Department of Oncology, Sant'Andrea Hospital, Sapienza University of Rome.
authors.forename: A
authors.initials: A
authors.lastname: Costantini
authors.forename: A
authors.initials: A
authors.lastname: Picardi
authors.forename: M
authors.initials: M
authors.lastname: Zilli
authors.forename: F
authors.initials: F
authors.lastname: Cairoli
authors.forename: R
authors.initials: R
authors.lastname: Torta
authors.forename: P
authors.initials: P
authors.lastname: Marchetti
authors.forename: W
authors.initials: W
authors.lastname: Baile
authors.forename: S
authors.initials: S
authors.lastname: Iacobelli
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D006801:Humans; D007558:Italy; D009364:Neoplasm Recurrence, Local; D010817:Physician-Patient Relations; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013629:Tamoxifen / Q000191:economics / Q000627:therapeutic use
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D013629:Tamoxifen