U-M study finds women involved in choosing surgeon more likely to be treated by experienced surgeon, at accredited cancer center

ANN ARBOR, Mich. - Women who took more control over choosing their breast cancer
surgeon were more likely to be treated by more experienced breast surgeons and at
a hospital affiliated with an accredited cancer program, compared to women who were
referred by another doctor or their health plan, according to a study led by researchers
at the University of Michigan Comprehensive Cancer Center.

The study looked at 1,844 women recently diagnosed with breast cancer in the Detroit
and Los Angeles metropolitan areas. Information was collected from the Surveillance,
Epidemiology and End Results Registry, a database maintained by the National Cancer
Institute that collects information about cancer incidence, treatment and mortality.
Results of the study appear in the Jan. 20 issue of the Journal of Clinical Oncology.

The women were surveyed about how the breast surgeon was selected, with choices
such as "I was referred by another doctor,” “I chose this surgeon because of his
or her reputation” or “I wanted a surgeon who practiced near my home.” Based on
the answers, patients were categorized as being referred to their surgeon or selecting
their surgeon based on reputation or proximity.

Nearly two-thirds of the patients said they were referred to their surgeon by another
doctor, with another 15 percent referred by their health plan. About a quarter chose
their surgeon based on reputation. Women with more education and higher incomes
were more likely to report selecting their surgeon based on reputation.

About one-third of the women were treated by a high-volume surgeon - a surgeon who
devoted more than half of his or her practice to breast surgery. Also, two-thirds
of the women were treated in a hospital with a cancer program approved by the American
College of Surgeons or a National Cancer Institute-designated cancer center.

Women who selected their surgeon based on reputation were more likely to be treated
by a high-volume surgeon and more likely to be treated at an NCI or American College
of Surgeons-approved cancer center, the researchers found. Women who said their
doctor or health plan referred them to a surgeon were less likely to be treated
at an NCI-designated cancer center.

“Women with breast cancer should be aware that referrals from another doctor or
their health plan may not connect them with the most experienced surgeons or the
most comprehensive practice settings in their community. Patients might consider
seeking a second opinion, especially if they are advised to undergo a particular
treatment without a full discussion of the options,” says study author Steven Katz,
M.D., MPH, professor of internal medicine at the U-M Medical School and director
of Health Services Research at the U-M Comprehensive Cancer Center. Katz is also
professor of health management and policy at the U-M School of Public Health.

"Katz and colleagues have performed a valuable service by identification of
the importance of structure, which they define in terms of the individual providers
linked to patients and the volume associated with those providers," Katherine
Kahn, M.D., professor of internal medicine at UCLA Medical Center, says in an accompanying
editorial.

Katz has recently received three new grants from the National Cancer Institute to
further this work. These new studies will examine whether patient satisfaction and
quality of life differ depending on how doctors and staff communicate with each
other and with their patients in different practice settings.

In addition to Katz, study authors were Timothy Hofer, M.D., M.S., and Sarah Hawley,
Ph.D., both from the U-M Department of Internal Medicine and the VA Ann Arbor Healthcare
System; Paula Lantz, Ph.D., and Nancy Janz, Ph.D., both from the U-M School of Public
Health; Kendra Schwartz, M.D., MSPH, from Karmanos Cancer Institute; Dennis Deapen,
Ph.D., from the University of Southern California; and Monica Morrow, M.D., from
Fox Chase Cancer Center.