Numerous large trials involving more than 100 000 patients have documented that adjuvant chemotherapy (AC) leads to considerable reductions in breast cancer–related mortality.1 Despite the well-documented survival benefits, a proportion of women for whom AC is indicated may delay or completely fail to initiate AC. This is a cause for considerable concern, as supported by the results of a systematic review and meta-analysis of 7 studies involving more than 34 000 women treated surgically for breast cancer, indicating that overall and disease-free survival is reduced by 15% and 16%, respectively, for every 4-week delay in initiation of AC.2 It is therefore of urgent interest to determine the factors associated with noninitiation of AC. With respect to patient decisions to delay or ultimately reject AC all together, a complex interaction of sociodemographic, clinical, and psychosocial patient characteristics, as well as oncologist factors, are likely to be at play.
Zachariae R. Complementary and Alternative Medicine Use Among Patients With CancerA Challenge in the Oncologist-Patient Relationship. JAMA Oncol. 2016;2(9):1177–1178. doi:10.1001/jamaoncol.2016.0713
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