Getting the best treatment is what all women diagnosed with breast cancer want. Excellent care requires an informed and experienced medical team that can choose the best treatment plan for each woman's unique situation. The results of two research studies reviewed here suggest that this doesn't always happen.
In one study, researchers found that obese women or women with little education who had been diagnosed with breast cancer were nearly twice as likely to receive a lower-than-recommended dose of chemotherapy. If you get a chemotherapy dose that's lower than you need, it can affect how well the breast cancer responds. A low dose also can affect the risk of the breast cancer coming back after treatment (recurrence). Similar results were found in research published in 2005.
Some doctors worry about possible risks associated with giving a high dose of chemotherapy calculated using an obese woman's weight. Others worry about giving a high dose of chemotherapy to obese women who have other medical problems. It's with good intentions that these doctors may decide to decrease the dose of chemotherapy. But research has shown that obese women who receive the correct dose of chemotherapy based on their weight and height don't experience any extra problems from the treatment. It's harder to explain why women with little education are more likely to receive lower doses of chemotherapy for breast cancer. The researchers don't really give any explanation.
No matter what you weigh or how much education you have, getting the full dose of chemotherapy for your height and weight is important. If chemotherapy is recommended for you, ask your doctor about how your chemotherapy doses will be chosen. This is a chance for you to tell your doctor that you are committed to getting the most effective chemotherapy for you.
Choosing the right treatment plan for you starts with choosing the right treatment team. The second research study reviewed here found that women who carefully chose their breast cancer doctors were more likely to have a more experienced treatment team.
Making a decision about your treatment team is a decision about the rest of your life. Do your homework. Credentials and experience matter. Consistent recommendations from other people, both health care professionals and friends, are also important. But even the smartest and most experienced doctor can't give you excellent care unless you communicate well with the people on your treatment team.
You deserve excellent care. But you also have to be an active and effective voice in your care. Don't leave it to chance and don't be silent if you have a question. Together, you and your doctors can find the best treatment for you.
WASHINGTON (Reuters) - Breast cancer patients who are either obese or poorly educated are twice as likely to get lower-than-optimal doses of chemotherapy, U.S. researchers reported on Thursday.
The finding, published in the Journal of Clinical Oncology, may help explain why some women relapse and others do not, despite the availability of good treatments for the disease.
The problem appears to be with doctors who mean well and want to avoid causing side effects in their patients, the team at the University of Rochester Medical Center in New York found.
"Simply put, this evidence shows that doctors are likely to reduce the chemotherapy levels for these women, even though there is no solid medical basis to do it," said Dr. Gary Lyman, who led the study.
They looked at the records of 764 women treated for breast cancer between 2002 and 2005 at 115 randomly selected, private oncology practices around the country.
They found that 21 percent of obese women received less than 85 percent of the standard dose for their weight. But just 10 percent of lean women were undertreated.
More than 32 percent of women who did not graduate from high school got lower-than-recommended doses, compared with 14 percent of high school or college-educated women.
"We have new therapies and cures out there for many forms of cancer and sadly, sometimes we're not curing people because they are not getting the full doses that should be standard," Lyman said in a statement.
A second study in the same journal found women who carefully chose their own breast cancer surgeon tended to get more experienced surgeons and care at specialized centers, compared to women referred by another doctor or their health plan.
The team at the University of Michigan Comprehensive Cancer Center examined the cases of 1,844 women recently diagnosed with breast cancer in Detroit and Los Angeles.
More than 60 percent of the patients said they were referred to their surgeon by another doctor, and 15 percent were referred by their health plans. About 25 percent chose their surgeon based on reputation.
Women with more education and higher incomes were more likely to have chosen their own surgeon.
Evidence shows that patients who choose any type of doctor based on their experience tend to do better. For surgery, patients recover better if they choose a hospital or clinic where the operation is performed frequently.
"Women with breast cancer should be aware that referrals from another doctor or their health plan may not connect them with the most experienced surgeons or the most comprehensive practice settings in their community," said Dr. Steven Katz, who led the Michigan study.
"Patients might consider seeking a second opinion, especially if they are advised to undergo a particular treatment without a full discussion of the options."
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