“System Mistrust” Interferes With Post-Surgery Breast Cancer Treatments - NFCR


“System Mistrust” Interferes With Post-Surgery Breast Cancer Treatments

BALTIMORE — A study led by a Johns Hopkins Bloomberg School of Public Health researcher indicates nearly one-third of breast cancer surgery patients went against their doctor’s advice, choosing to not begin or complete adjuvant anti-cancer therapy. The primary factor: a general mistrust of the American healthcare system.

Adjuvant therapy for breast cancer, usually chemotherapy, hormone therapy or radiation treatment, is a post-surgery procedure meant to kill any cancer cells not eliminated by the initial operation. It is widely regarded as necessary, and research has shown that adjuvant therapy on average reduces the likelihood of breast cancer’s recurrence and increases patients’ chances of long-term survival.

A survey asked participants about their trust in their doctors and in the healthcare system in general, with researchers using the patients’ responses to place them into high and low categories of general health care system distrust. A subsequent analysis found that those in the “high-distrust” category, compared to those in the lower-distrust category, were about 22 percent more likely to report not having followed their doctor’s full set of recommended treatments. Published in Cancer Epidemiology, Biomarkers & Prevention, this study is by far the largest evaluation of this issue.

The survey included 2,754 breast cancer patients in Florida and Pennsylvania during a two-year period. Sixty-nine percent of patients were white, 27 percent were black/African-American and four percent identified as another race or ethnicity. The key finding is that “treatment discordance” (not following a doctor’s recommended treatment plan in its entirety) was more likely among patients in the survey who reported distrust of medical institutions and insurers. The patients’ trust or distrust of their own doctors did not seem to be a factor.

 “If we want more women with breast cancer to complete their treatment, we’ll need to deal with their beliefs about the healthcare system, and I do think we can modify those beliefs,” says Lorraine T. Dean, ScD, assistant professor in the Bloomberg School’s Department of Epidemiology and the study’s lead author.

“Improving health care system distrust may require strategies that are not solely focused on boosting physician trust,” Dean says. “If ordinary businesses can learn to increase trust in their brands, why not the same with healthcare institutions?”


  • Dean, Lorraine T., et al.  (2017, November)  Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations.  Baltimore, MD: Johns Hopkins Bloomberg School of Public Health

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