Health Care System Distrust Drives Treatment Nonadherence in Patients With Breast Cancer

11/05/17

A recent survey found that approximately 33% of patients with breast cancer forego their physician-recommended adjuvant therapies due to distrust in medical institutions and insurers.

Results of the survey were published in Cancer Epidemiology, Biomarkers & Prevention (online September 29, 2017; doi:10.1158/1055-9965.EPI-17-0479).

Prior small studies have found that not all patients with breast cancer adhere entirely to adjuvant therapy recommendations because of a general distrust in medical institutions. However, larger studies are needed to validate this relationship and to determine whether physician distrust plays a role in nonadherence as well.

Lorraine T Dean, ScD, assistant professor, Johns Hopkins Bloomberg School of Public Health, and colleagues sought to better understand this issue of trust by administering a large survey to patients with breast cancer in Florida and Pennsylvania. All patients diagnosed with invasive, localized breast cancer between 2005 and 2007 aged 65 or less from both states were mailed a survey.

After a response rate of 61%, researchers had gathered data from 2754 respondents regarding self-reported demographics, cancer stage and treatments, treatment discordance (defined by not following surgeon or oncologist treatment recommendation), health care system distrust, and physician trust.

Among the total respondents, 30.2% (n = 832) reported not completing at least one recommended adjuvant therapy. Eighteen percent of this cohort had not undergone some or all of the recommended hormone therapy, with the remaining 82% evenly split between discordance with radiation treatment and chemotherapy.

Researchers classified patient responses about trust in physicians and the health care system into high and low categories of general distrust. They found that patients in the “high-distrust” category were 22% more likely to report not having adhered to their physician’s full set of recommended treatments. Researchers found that physician trust did not mediate the association between health care system distrust and treatment discordance.

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In their concluding remarks, authors of the study stated that health care system distrust is significantly associated with adjuvant treatment discordance in patients with breast cancer, and that patient attitude toward physicians is not a significant factor for this discordance.

“If we want more women with breast cancer to complete their treatment, we’ll need to deal with their beliefs about the health care system,” said Dr Dean in a statement (November 1, 2017).—Zachary Bessette