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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention

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Research Article

Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations

Lorraine T. Dean, Shadiya L. Moss, Anne Marie McCarthy and Katrina Armstrong
Lorraine T. Dean
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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  • For correspondence: ldean9@jhu.edu
Shadiya L. Moss
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
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Anne Marie McCarthy
Massachusetts General Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts.
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Katrina Armstrong
Massachusetts General Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts.
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DOI: 10.1158/1055-9965.EPI-17-0479
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Abstract

Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust.

Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust.

Results: Of the 2,754 participants, 30.2% (n = 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance.

Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer.

Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance. Cancer Epidemiol Biomarkers Prev; 26(12); 1–8. ©2017 AACR.

Footnotes

  • Note: L.T. Dean and S.L. Moss are co-first authors of this article.

  • Received June 1, 2017.
  • Revision received August 7, 2017.
  • Accepted September 18, 2017.
  • ©2017 American Association for Cancer Research.
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Published OnlineFirst November 21, 2017
doi: 10.1158/1055-9965.EPI-17-0479

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Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations
Lorraine T. Dean, Shadiya L. Moss, Anne Marie McCarthy and Katrina Armstrong
Cancer Epidemiol Biomarkers Prev November 21 2017 DOI: 10.1158/1055-9965.EPI-17-0479

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Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations
Lorraine T. Dean, Shadiya L. Moss, Anne Marie McCarthy and Katrina Armstrong
Cancer Epidemiol Biomarkers Prev November 21 2017 DOI: 10.1158/1055-9965.EPI-17-0479
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Cancer Epidemiology, Biomarkers & Prevention
eISSN: 1538-7755
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