A UNC doctor received an $862,700 grant to study the decision making process of breast cancer survivors considering breast reconstruction surgery.
Dr. Clara Lee—UNC School of Medicine physician, scientist, assistant professor of surgery and member of the UNC Lineberger Comprehensive Cancer Center—will study decision psychology of patients’ choices to help provide better care for women facing reconstructive surgery.
“A lot of women who have a mastectomy don’t get breast reconstruction and that the rates of breast reconstruction vary so widely by where you live and your race and your socio-economic status,” Lee said. “I consider a part of my responsibility in talking to them is to make sure that they understand and have a balanced set of information given to them.”
The study will strive to educate patients and promote informed decisions before women undergo a mastectomy.
Lee officially received the $862,700 career development grant on September 1st from the National Institutes of Health to fund a study of the decision making processes women go through concerning breast reconstruction after a mastectomy.
“A lot of women who have a mastectomy don’t get breast reconstruction and that the rates of breast reconstruction vary so widely by where you live and your race and your socioeconomic status,” she said.
Lee exercised the connection between the clinical and research worlds by questioning women who came to her for reconstruction after having a mastectomy. She found many women are not initially informed of a reconstruction option, and some already have their minds made up about the procedure based on a friend’s story or images they have seen from others.
“Being diagnosed with breast cancer and making decisions about treatment can be a really emotional experience for a lot of women,” Lee said. “Operating on the breast is so intimately tied to how women look and how they feel about themselves.”
Lee concluded that none of the studies done on pre-operative emotional health effectively examined how it affects quality of life after breast reconstruction.
This emotional cause-and-effect perspective can be seen in the stories of women like Kimberly Thigpen-Tart, a 43-year-old breast cancer survivor and mother of four from Chapel Hill. She described her decision to have reconstructive surgery as well informed and firm.
“Both of my grandmothers and my mother had breast cancer and they had all had unilateral mastectomies, so I had grown up seeing how cumbersome it was to wear prosthetics,” Thigpen-Tart said.
As a survivor, Thigpen-Tart strongly emphasizes the importance of breasts as an integral part of a woman’s body. She views advocacy and treatment as forces that should be catering to the benefit of the mental, emotional and physical wellbeing of the whole woman, not just a portion of her body.
Lee will use conjoint analysis to elicit patient preferences on reconstruction and use them to create scenarios with which to question patients with the goal of uncovering a true answer, one that reflects the whole woman, rather than a premeditated one reflecting a part.
“Sometimes what we think we know about ourselves is not all that clear, but when we break it down in these kinds of scenarios we can really tell just how important it is to you, especially in relation to competing factors,” Lee said.
Dr. Mike Pignone of UNC and Dr. Peter Ubel of Duke University, both experts on medical decision making, will mentor Lee throughout the study. They will be joined by a panel of mostly UNC mentors with differing expertise. Lee will also work with a team of biostatisticians from the UNC Lineberger Center and an advisory board consisting of an ethics core and two breast cancer survivors who advise research studies from a survivor’s perspective.
This article was reported as a part of the JOMC 253 Reporting course at UNC’s School of Journalism and Mass Communication.
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