Lack of trust in system leads breast cancer patients to forgo adjuvant treatment

Robyn Boyle, RPh, for MDLinx | November 09, 2017

A new study from the Johns Hopkins Bloomberg School of Public Health reports that almost one-third of women are not compliant with recommended postsurgical treatment for breast cancer, due in part to a lack of trust in the health care system. Mistrust of hospitals, insurers, and pharmaceutical companies was associated with not continuing adjuvant treatment. However, trust in the doctor was not a factor.


Patients who ranked in the category of ‘high distrust’ of the health care system were more likely to not follow their doctor’s recommended regimen.

The goal of adjuvant therapy after breast cancer surgery is to kill residual cancer cells not removed by surgery. These therapies include chemotherapy, radiation, and hormone therapy. Although adjuvant therapies can prevent recurrence and extend survival, many women either delay recommended therapy, never start, or start but don’t finish.1

In a study published in Cancer Epidemiology, Biomarkers & Prevention, the authors suggested that distrust of the health care system is a modifiable factor that may be responsive to an intervention.

“If we want more women with breast cancer to complete their treatment, we’ll need to deal with their beliefs about the healthcare system,” said Lorraine T. Dean, ScD, the study’s lead author. “I do think we can modify those beliefs.”

Surveys were mailed to women under the age of 65 who are listed in Pennsylvania and Florida cancer registries as diagnosed with localized invasive breast cancer. The participants reported demographics, cancer stage and treatments, treatment discordance (not following recommended treatment), health care system distrust, and physician trust.

Of the 2,754 women who responded to the survey, 832 (30.2%) indicated that they did not receive at least one recommended treatment (discordance therapy breakdown: 10% radiation therapy, 11% chemotherapy, 18% hormone therapy).

Treatment discordance was significantly less common among married women in the study. It was more common in those who made between $30,000 and $70,000/year, and in women with stage 1 breast cancer. Patients who ranked in the category of ‘high distrust’ of the health care system were more likely to not follow their doctor’s recommended regimen. More than 95% of the women in the study had some form of insurance.

The authors concluded that distrust of the health care system played a role in non-compliance of breast cancer patients prescribed adjuvant therapy. They stated it is important to address and improve patient’s attitudes to allow them full benefit of treatment.

“If ordinary businesses can learn to increase trust in their brands, why not the same with health care institutions?” Dr. Dean asked.

To read more about the study, click here


1. Neugut AI, et al. Breast Cancer Res Treat. 2016;158(1): 127–138.