Some patients need louder voice in cancer care

Younger people, ethnic minorities, and persons with certain types of cancer are more likely to report having less input into decisions regarding their treatment, indicates a study in British Journal of Cancer (2013;109:780-787).

A national survey conducted in England showed that 29,776 of 41,441 (72%) patients attending hospitals for cancer treatment over a 3-month period reported positive experiences of decision-making involvement. However, respondents younger than age 55 years reported the most negative experience of involvement in treatment decisions, consistent with evidence from many other patient surveys cited by Anas El Turabi and fellow investigators from the Cambridge Centre for Health Services Research at the University of Cambridge (Cambridge, United Kingdom).

In another result concordant with previous findings, ethnic minority patients reported poorer experiences of involvement in treatment-related decisions. Compared with white patients, black patients reported the most negative experiences, followed by Chinese patients.

Satisfaction with decision-making experiences also varied based on cancer type: El Turabi and colleagues found that when considering the most common cancers, persons with melanoma were substantially more likely to report the most positive experiences, whereas persons with anal cancers or myeloma reported the most negative experiences.

In addition, the analysis uncovered large differences in the experience of decision-making involvement between patients suffering from cancers of the same system and receiving treatment from within the same specialty service. Persons with ovarian cancer, myeloma, bladder cancer, or rectal cancer reported substantially worse experiences than did other patients with gynecologic, hematologic, urologic, or colorectal cancers, respectively.

El Turabi and associates noted that these variations could not be explained by concentration of patients reporting more negative experiences in certain hospitals.  

In a statement from the University of Cambridge, coauthor Georgios Lyratzopoulos, also of the Centre for Health Services Research, pointed out that despite differences between the UK and US health care systems, “We would expect to find similar variation between American patients with different cancers.”

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