title: Recurrence risk perception and quality of life following treatment of breast cancer.
abstract: Little is known about different ways of assessing risk of distant recurrence following cancer treatment (e.g., numeric or descriptive). We sought to evaluate the association between overestimation of risk of distant recurrence of breast cancer and key patient-reported outcomes, including quality of life and worry.
  
  
  
  We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer identified through SEER registries of Los Angeles County & Georgia (2013-14) ~2 months after surgery (N = 2578, RR = 71%). Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low-risk invasive cancer (Stg 1A, ER+, HER2-, Gr 1-2). Women reported perceptions of their risk numerically (0-100%), with values ≥10% for DCIS & ≥20% for invasive considered overestimates. Perceptions of "moderate, high or very high" risk were considered descriptive overestimates. In our analytic sample (N = 927), we assessed factors correlated with both types of overestimation and report multivariable associations between overestimation and QoL (PROMIS physical & mental health) and frequent worry.
  
  
  
  30.4% of women substantially overestimated their risk of distant recurrence numerically and 14.7% descriptively. Few factors other than family history were significantly associated with either type of overestimation. Both types of overestimation were significantly associated with frequent worry, and lower QoL.
  
  
  
  Ensuring understanding of systemic recurrence risk, particularly among patients with favorable prognosis, is important. Better risk communication by clinicians may translate to better risk comprehension among patients and to improvements in QoL.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. sarahawl@umich.edu.|Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA. sarahawl@umich.edu.|Ann Arbor VA Center for Clinical Management Research, Ann Arbor VA Health Care System, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, USA. sarahawl@umich.edu.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.affiliation: Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
authors.affiliation: Departments of Medicine and Health Research and Policy, Stanford University, Stanford, CA, USA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Wallner
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010465:Perception; D011159:Population Surveillance; D011788:Quality of Life; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D018426:SEER Program
keywords: Breast cancer; Perception; Quality of life; Risk