According to our long-term follow-up research of a large size sample, disclosure of patients’ diagnosis was found to be a protective factor for the longer survival time of patients with breast cancer through univariate and multivariate analyses. Age, clinical-stage, surgical history and diagnosis year were also associated with patients’ survival time.
The disclosure of cancer diagnosis to patients with breast cancer has always been a contentious topic all over the world. Owing to the different cultural backgrounds of different countries, opinions on this topic are varied. There was a survey indicated that in the United Kingdom, almost all patients wanted to be aware of their diagnosis while in Asian culture, physicians and family members may worry more about whether to inform. What’s more, there is a change of attitude when the hypothetic diagnosis changed from the initial stage to the terminal stage. The percentage of those who wanted to reveal the diagnosis to patients decrease significantly (from 87.5%-40.5%) . The reasons for physicians and family members hesitating to disclose the real to patients may include psychological impact and pain of treatment needed to undergo, especially the loss of physical integrity. It has been proved that losing a breast by mastectomy could bring about severe mental impairments resulted from body image, female identity, self-worth, social interactions and so on .
In this study, we found that the popularization of making patients know the diagnosis is increasing year by year, and the disclosure of patients’ diagnosis is an independent protective factor for patients with breast cancer to prolong their survival time. Patients without knowing their real condition may form unrealistic optimism which may lead to an unhealthy lifestyle making their condition worse. In contrast, having a clear perspective of their cancer status will lead to a healthier way of life. Informing patients of their breast cancer as early as possible assists them to have a precise knowledge of themselves. What’s more, there are many strategies to help patients cope with their emotional distress such as psychological care and breast reconstruction, which have had some effectiveness already [28, 29].
In male patients’ subgroup, diagnosis disclosure was not linked with survival time. Male breast cancer is uncommon, and there were only 93(0.75%) male patients involved in our study. Similarly, there were 2470 (0.98%) men with breast cancer in the USA while 252,710 women with breast cancer in 2017 . Since most data for breast cancer research are from female patients, men tend to be diagnosed with breast cancer at a later age than women since most treatment and diagnostic decisions are made by female patients’ data . In addition, breast cancer appeared in female patients more frequently, therefore, male patients may undergo a special perceptual experience. Because of the gender stereotype, male patients knowing their diagnosis were more likely to have a high level of cancer-specific distress and depressive symptoms . More researches may be needed on the psychological state of this particular and rare group.
Our study found that disclosure of cancer status and other factors such as female, younger age, earlier clinical stage, surgical history, and more recent diagnostic year were significantly related to better survival. The more recent diagnostic year predicts a shorter time for cancer to develop and more advanced treatment to receive. In addition, there were more patients being told of their own cancer status in which group was diagnosed currently. Therefore, patients with these conditions may have a better prognosis.
In our study, we use a narrow definition of cancer disclosure, only focusing on informing patients of their cancer diagnosis, but not considering the patient’s knowledge of treatment, prognosis, and other relevant information. We didn’t obtain detailed information about the treatment that participants were received, which may influence the final result of participants. Because of challenges in data collection and uncertainty, some potential factors such as psychological condition of patients, education level and income were not included. In the following research, patients might be concerned about their own conditions, however, the decision patients’ families made at the first time may reflect patients’ characteristics to some extent. So we regarded their diagnosis were concealed if they didn’t know their own condition when they were enrolled in our study. Despite the above limitations, this retrospective cohort study provides clear evidence to promote the diagnosis disclosure to breast cancer patients through long-term follow-up of a large sample size, which hopefully offer a new direction in clinical practice.
Our study offered consequences that more and more medical staff and patients’ families are more and more willing to disclose the truth to patients according to our analysis on diagnostic year, which implies that knowing cancer status predicts a better prognosis and longer survival time than those who don’t know. It is positive evidence suggests that disclosing the diagnosis to patients does better to patients’ survival with breast cancer. Previous studies showed that most patients were ready to have sufficient knowledge of their diagnosis while the majority of medical staff and families were not . The reason for this phenomenon may be that it is a difficult task of revealing cancer diagnosis to patients, which would make physicians feel uncomfortable and unprepared [34, 35]. With the consent right becomes ever more common, the debate between whether to tell patients their diagnosis would be replaced by how and when to tell. Existing guidelines for breaking bad news based on expert opinion are available . However, some guidelines were found not completely derived from empirical data . Therefore, formal guideline for breaking bad news is necessary to be made. Furthermore, oncological care for patients is also needed to help them keep a positive attitude towards their cancer status and overcome their emotional distress .