Informal Decision Analysis with Breast Cancer Patients

Treatment for early breast cancer poses a dilemma: evidence suggests that mastectomy or lumpectomy plus radiotherapy may be equally effective. In the present study, 43 women received one of these two treatments. Whenever medically feasible, the patients were allowed to choose their own treatment. When they needed help in deciding, an informal decision analysis (IDA) based on the principles of Bayesian decision analysis was conducted to help them choose. Those who needed a mastectomy were offered breast rcconstruction. Tests of anxiety, depression, body satisfaction, marital adjustment, self-esteem, sociability, and life change were administered to the patients before surgery and at intetvals up to one year after treatment to assess their psychological adaptation to treatment. Psychological adaptation has been good in all groups. According to patients' reports, the reason is that those to whom appearance was paramount could choose conservative surgery or, if mastectomy was necessary, could choose subsequent breast reconstruction, whereas those to whom appearance was not of primary importance could choose mastectomy. The IDA procedure may prove to be useful in helping women decide which treatment for breast cancer is optimal for them.