title: Patient satisfaction with service quality as a predictor of survival outcomes in breast cancer.
abstract: OBJECTIVE
  Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer.
  
  
  METHODS
  A random sample of 1,521 breast cancer patients treated at Cancer Treatment Centers of America. A questionnaire which covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from "completely dissatisfied" to "completely satisfied". Univariate and multivariate Cox regression was used to evaluate the association between patient satisfaction and survival.
  
  
  RESULTS
  Of 1,521 patients, 836 were newly diagnosed, and 685 had previously been treated. A number of 409, 611, 323, and 178 patients had stage I, II, III, and IV disease, respectively. A total of 1,106 (72.7 %) patients were completely satisfied with the overall service quality, while 415 (27.3 %) were not. On univariate analysis, completely satisfied patients had a significantly lower risk of mortality compared to those not completely satisfied (HR = 0.62; 95 % CI 0.50-0.76; p < 0.001). On multivariate analysis, completely satisfied patients demonstrated significantly lower mortality (HR = 0.71; 95 % CI 0.57-0.87; p = 0.001) compared to those not completely satisfied.
  
  
  CONCLUSIONS
  Patient satisfaction with service quality was an independent predictor of survival in breast cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they receive and outcomes in breast cancer is indicated.
authors.affiliation: Cancer Treatment Centers of America®, 1336 Basswood Road, Schaumburg, IL, 60173, USA, digant.gupta@ctca-hope.com.
authors.forename: Digant
authors.initials: D
authors.lastname: Gupta
authors.forename: Mark
authors.initials: M
authors.lastname: Rodeghier
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Lis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D016896:Treatment Outcome