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What quality-of-life issues do women with ductal carcinoma in situ (DCIS) consider important when making treatment decisions?

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Abstract

Purpose

To explore quality-of-life (QOL) issues considered important when deciding on treatment for ductal carcinoma in situ (DCIS).

Methods

Breast Cancer Network of Australia members diagnosed with DCIS in the past 5 years (self-identified) participated in an online survey (Sep–Nov 2015). From a list of 74 QOL issues, participants selected all issues they experienced during DCIS diagnosis, treatment or recovery, then the issues they felt important to making a DCIS treatment decision, and completed the Health Literacy Questionnaire (HLQ). Associations between QOL issues and self-reported treatment received were assessed with χ 2 tests.

Results

The primary analysis included 38 participants treated with breast-conserving surgery (n = 15), mastectomy (n = 23), and/or radiotherapy (n = 14). Fatigue-related symptoms (82%) and “fear of progression” (50%) were the most frequently-experienced issues. When deciding on DCIS treatment, the most important consideration was “fear of progression” (50%). A higher proportion of mastectomy (compared to non-mastectomy) patients considered “difficultly looking at yourself naked” (p = 0.03). Radiotherapy (compared to non-radiotherapy) patients were more likely to consider “feeling unwell” important (p = 0.006). Results were similar in a sensitivity analysis involving all 101 respondents (i.e., including 63 respondents who reported receiving chemotherapy, endocrine therapy, and/or Herceptin, suggesting that they may have been treated for invasive breast cancer). Health literacy was high across all nine HLQ scales.

Conclusion

Fear of progression is a key consideration in DCIS treatment decision making for women with high health literacy. QOL treatment considerations differed by treatments received. Women diagnosed with DCIS may benefit from evidence about QOL to inform treatment decision making.

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Acknowledgements

Financial support for this study was provided entirely by a grant from the Medibank Health Research Fund. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. We are grateful to the team at BCNA for facilitating recruitment, particularly Lisa Morstyn, and to all the women who took part in the survey. This project received funding from Medibank Health Research Fund (PI King, December 2014). Professor King is supported by the Australian Government through Cancer Australia.

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Correspondence to Rebecca Mercieca-Bebber.

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Mercieca-Bebber, R., King, M.T., Boxer, M.M. et al. What quality-of-life issues do women with ductal carcinoma in situ (DCIS) consider important when making treatment decisions?. Breast Cancer 24, 720–729 (2017). https://doi.org/10.1007/s12282-017-0765-0

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