News Release

Breast cancer patients suffer through communication failure

Peer-Reviewed Publication

European Society for Medical Oncology

A study of nearly 1,000 women with breast cancer has painted a bleak picture of the quality of communication between health professionals and patients, and the impact that failure to communicate properly may have on patients' quality of life.

The report by German researchers to be published in the March issue of Annals of Oncology[1], reveals that nearly half the women judged that information they received on several medical aspects was incomprehensible or incomplete. Over half also wanted more opportunity to talk to medical staff. It is also possible that stressed patients were unable to process the information they were given, even if it was well delivered.

But, it doesn't have to be that way, say the researchers from the Munich Cancer Registry and the medical clinic at Ludwig Maximilians University. Improving communications is relatively cheap, can be done immediately and has major potential to yield benefits for patients.

There have been previous studies into breast cancer patients' quality of life in a number of countries. But four important differences meant the new research is particularly likely to be representative of breast cancer patients generally:

  • Length of follow-up – five years
  • Inclusion of a large number of older patients (often excluded from clinical trials)
  • It was prospective i.e. patients were asked how they felt at the time rather than asked to recall how they felt years before
  • It recruited patients in routine care from over 50 hospitals and there were none of the exclusion criteria e.g. age or disease state, that affect clinical trials

The objective was to examine the effect of communication on patients' quality of life and to investigate the role of age in the relationship[2].

Researcher Dr Jacqueline Kerr said:"We found that 45% reported that some aspect of communication was unclear and 59% wanted to speak with medical staff more. Most rated social and psychological help as important, yet only a third had contact with a self-help group, psychologist or social worker and in hospital only half the patients were aware of such support facilities. Overall quality of life differed by up to 10 points on a 0-100 scale between those reporting clear and unclear communication – a clinically significant amount."

Women left with arm problems – 47% in the first year of treatment and 60% over the five years – were particularly dissatisfied, with those who had received insufficient information having worse quality life.

Dr Kerr said: If clinicians better appreciated the prevalence and consequences of arm problems they might be encouraged to talk about it more openly with the patient, give more information about prevention and encourage patients to seek early treatment."

The effect of poor communication remained statistically significant for up to four years and the trend persisted throughout the entire period of the study. Dr Kerr said: "The effect of communication at the time of diagnosis will diminish and quality of life improve over time. However, research indicates that some cancer survivors continue to live in fear of recurrence and their needs are not addressed in routine care."

Younger and older patients reacted differently. Although patients under 50 reported less satisfaction, those who reported unclear information did not suffer significantly worse quality of life. Instead they rated psychological and group help as more important and wanted to talk more with other cancer patients, psychologists and social workers. The researchers believe that these sources of support would help younger patients to adjust better.

For patients over 50 however, although fewer judged communications as poor, quality of life was significantly worse if communication was unsatisfactory. The researchers called for greater effort to be made to communicate with older patients especially by larger hospitals, which appeared in particular to neglect this area.

Project director Dr Jutta Engel said there were a number of possible explanations for the different reactions of younger and older patients. "For most under 50s breast cancer will be their first experience of a serious illness. They are more likely to have young children or to be working and cancer therefore has a greater impact on their lives. As a breadwinner they will be more worried about dying when they are still in a position of responsibility. Under 50s are also on the edge of the 'information age' generation and are possibly more informed and have greater expectations.

"Our older group included a large number of over 75s who may have other conditions such as diabetes or heart disease and have therefore possibly addressed their own mortality. This generation may have lower expectations rather than lower needs and perhaps worries about taking up the doctor's time." She said their findings were likely to hold true for other countries although some, such as the UK and the Netherlands, have done research into training medical students in communications skills. Basic steps to improve the situation would include:

  • Training in communication skills for doctors so they improve their ability to ask 'open' questions, listen, empathise, evaluate patient needs and check understanding
  • Particularly distressed patients recognised and given special attention
  • Patients to be given a written or audio record of the consultation
  • Patients encouraged to bring a friend or relative to the consultation who can listen and ask questions
  • Patient access after diagnosis to further information, either from a doctor or information specialist
  • Patient access to sources that provide a list of appropriate questions

Dr Engel concluded: "Although these findings paint a bleak picture, it is vital to realise that much can be done to rectify the situation. In contrast to improvements in treatment, which are costly and slow to develop, information giving is a reasonably cheap intervention with much potential. The best time and way to deliver information, however, requires further research."

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[1] Communication, quality of life and age: results of a five year prospective study in breast cancer patients. Annals of Oncology. Vol.14. No 3. Pp 421-427.

[2] A total of 990 women with breast cancer out of 1,131 on the Munich Cancer Fieldstudy were involved in answering a series of questionnaires over five years, the first being sent six months after diagnosis. As well as establishing details of treatment, medicines and aftercare, the questionnaires covered a wide range of issues. The responses were converted to a 0-100 scale. [By year five, 243 patients were excluded due to disease progression].

Notes:
1 Annals of Oncology is the monthly journal of the European Society for Medical Oncology. Please acknowledge the journal as the source in any reports.
2 Annals of Oncology website: http://www.annonc.oupjournals.org
3 PDF of article available from Margaret Willson

Contact:
Margaret Willson (media inquiries only)
Tel: 44-153-677-2181
Fax: 44-153-677-2191
Mobile: 44-797-385-3347
Home tel: 44-153-677-0851
Email: m.willson@mwcommunications.org.uk

Professor David Kerr, editor-in-chief, Annals of Oncology
Tel: 44-186-522-4482
Fax: 44-186-579-1712
Email: david.kerr@clinpharm.ox.ac.uk


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