Originally published as JCO Early Release 10.1200/JCO.2007.10.9272 on July 16 2007

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Patient Satisfaction With Treatment of Breast Cancer: Does Surgeon Specialization Matter?

Jennifer F. Waljee, Sarah Hawley, Amy K. Alderman, Monica Morrow, Steven J. Katz

From the Section of General Surgery; Section of Plastic Surgery, Department of Surgery; Robert Wood Johnson Clinical Scholars Program; Division of General Medicine, Department of Internal Medicine; Department of Health Management and Policy, University of Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; and the Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Jennifer F. Waljee, MD, MPH, 6312 Medical Sciences Building I, 1150 W Medical Center Dr, Ann Arbor, MI 48109; e-mail: filip{at}med.umich.edu

Purpose Experience and practice setting vary greatly among surgeons who treat breast cancer patients. However, less is known about how these factors influence patient satisfaction with their care.

Patients and Methods We surveyed all ductal carcinoma in situ patients and a 20% random sample of invasive breast cancer patients diagnosed in 2002 reported to the Detroit, MI, and Los Angeles, CA, Surveillance, Epidemiology, and End Results registries. Attending surgeons were surveyed, yielding dyad information for 64.6% of patients (n = 1,539) and 69.7% of surgeons (n = 318). Logistic regression was used to examine the associations between surgeon specialization (percentage of practice devoted to breast disease) and hospital cancer program status, with four domains of patient satisfaction: (1) the surgical decision, (2) decision-making process, (3) surgeon-patient relationship, and (4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage.

Results In this sample, 34.5% of patients were treated by surgeons who devoted less than 30% (low volume) of their practice to breast disease, 32.5% by surgeons who devoted 30% to 60% (medium volume) of their practice to breast disease, and 33.0% by surgeons who devoted more than 60% (high volume) of their practice to breast disease. Compared to patients treated by low-volume surgeons, patients treated by higher volume surgeons were more satisfied with the decision-making process (medium volume, odds ratio [OR], 1.16; 95% CI, 0.80 to 1.67; high volume: OR, 1.79; 95% CI, 1.14 to 2.80) and with the surgeon-patient relationship (medium volume: OR, 1.13; 95% CI, 0.72 to 1.76; high volume: OR, 1.98; 95% CI, 1.08 to 3.61). Treatment setting was not associated with patient satisfaction after controlling for other factors.

Conclusion Surgeon specialization is correlated with patient satisfaction. Examining the processes underlying these associations can inform strategies to improve breast cancer care.

published online ahead of print at www.jco.org on July 16, 2007.

Funded by a grant from the National Cancer Institute (RO1 CA8837-A1) to the University of Michigan; funded in part with federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-PC-35139 and NO1-PC-65064. Collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885.

The ideas and opinions expressed herein are those of the author, and no endorsement by the State of California, Department of Health Services is intended or should be inferred.

Presented at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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