Decisions to undergo chemopreventive therapy influenced greatly by health care professionals recommendation

For women at high-risk for breast cancer who are trying to decide whether to take selective estrogen receptor modulators (SERMs), a health care professional’s recommendations may be the most important determining factor, according to study results published in the journal Cancer Prevention Research.

“We were surprised how clear-cut our findings were. The health care professional’s recommendation to take a SERM was paramount. None of the other characteristics related to the counseling session came close in importance,” said senior researcher and lecturer, Christine Holmberg, PhD, MPH, Institute of Public Health, Charité–Universitätsmedizin, Berlin, Germany. “We also found that the health care professional’s recommendation for taking a SERM was more likely to be followed by women with a positive attitude about taking medication.”

Currently two SERMs—tamoxifen and raloxifene—are approved by the FDA and have been shown to reduce breast cancer risk by up to 50% in clinical trials. Low adoption of the use of SERMs, however, remains an issue.

With this study, researchers sought to quantify the factors that influence the use of SERMs among women at high risk for breast cancer. They surveyed 1,023 American women from community care. Respondents were required to complete a survey immediately after a counseling session with a health care professional, and then again after they made a decision to take a SERM or not.

In the survey, researchers included topics discussed by the health care professionals with patients, and these encompassed a range of treatment options for risk reduction, SERM benefits and risks, receiving information via numbers or words. Researchers also collected patient input on various social, cultural, and psychological factors.

In all, 726 women made a decision, of whom 44.6% decided to take a SERM, while 55.4% did not. Researchers found that the health care professionals’ recommendations played a statistically significant role, and indeed, were the most important factor influencing the decision.

Other factors found to be associated with these decisions included attitudes about taking medication, worry about developing breast cancer, trust in the health care professional, having a family member with clotting issues, and knowledge about others’ experiences in taking SERMS. Menopausal status, however, had no measureable effects.

“Our research suggests that it is not enough to present medical facts and information about risks and benefits of SERMs to patients who have an increased risk for breast cancer,” added Dr. Holmberg. “Helping them find the prevention approach that is right for them is crucial. Health care professionals need to take patients’ attitudes, beliefs, and experiences into account and make a recommendation, one way or the other.”

Dr. Holmberg noted that they did not verify the actual SERM usage or adherence to therapy of women reporting a decision to take a SERM. An additional limitation of the study was that the large number of women indicating an interest in SERM use could reflect that they were already in clinical care for breast cancer risk.

The Decision-Making Project-1 study was conducted by the former National Surgical Adjuvant Breast and Bowel Project, a clinical trials cooperative group now known as NRG Oncology, a member of the National Cancer Institute (NCI) National Clinical Trials Network. The study was sponsored by the National Institutes of Health.