Men and Women Use Different Strategies to Choose Cancer Treatments

Do men and women use different strategies to choose cancer treatments? A study gets people talking about how patients make medical decisions, and what can be done to guide them. MARILYN FENICHEL Do gender stereotypes factor into the cancer experience? A study conducted by a major cancer center suggests that they do. When it comes to making treatment decisions, approaches used by newly diagnosed breast and prostate cancer patients break down along stereotypical gender lines, according to the study commissioned by Memorial Sloan Kettering Cancer Center in New York. Men were more deliberative, analytical, and data-driven in their approach, while women were more emotional when making their decisions. The results have sparked analysis and debate but, ultimately, health care professionals have seen them as an opportunity to learn what their patients need, and to do a better job of guiding them through the decision-making process. Looking at Results Treato, a health care data analytics company hired by Sloan Kettering, conducted the study. Turning to online support groups, Treato culled posts from both breast and prostate cancer sites between 2012 and 2014. For prostate cancer, the company assessed 1,339 posts, from which 633 were chosen for further study because they mentioned treatment decisions and/or Sloan Kettering. On the breast cancer side, Treato looked at 3,585 posts before selecting 808 posts. The company then analyzed these posts and used them as the basis for its conclusions. The research team found that prostate cancer patients rely on the latest studies about treatment options, as well as experts’ advice from books recommended online. They are more likely to weigh the cost-benefit ratio of treatments and take the time to consider the pros and cons of each of their choices. Even when discussing emotions, male patients communicate in matter-of-fact language, talking about their feelings in terms of quality-of-life and length-of-life concerns. Women, on the other hand, tend to have a more emotional reaction to their diagnosis. Their desire to avoid “going through this whole thing again” takes center stage, often resulting in their choice of the most aggressive therapy— bilateral mastectomy. They appear to be more distrustful of their physicians and instead seek guidance from their online peers, who have gone through a similar experience. Women often discuss fear of recurrence and are influenced by stories of other women whose cancer recurred after not pursuing aggressive therapy. Avice Meehan, chief communications officer at Sloan Kettering who commissioned the study on behalf of the marketing department, expressed surprise at these findings. Nonetheless, she views them as a way to better understand Sloan Kettering patients and those who look to the cancer center for information. “We want to better serve the broader community by having a compelling and well-informed picture of what people are experiencing during the early stages of their cancer journey,” she says. Putting the Findings Into Perspective Spurred by senior leadership, this study is part of a larger initiative at Sloan Kettering to “think long and hard about the patient experience and how we engage with our audience,” notes Meehan. “In particular, we’re trying to put ourselves in the shoes of those seeking information from us on our website. Our goal is to make the information and language ‘speak to them’ and ensure that the site is easy to navigate.” Meehan acknowledges that this was by no means a highly quantitative or randomized scientific study but “a way to gain some information from people who turn to online communities at a very stressful moment in their lives.” She adds that these two types of cancer were chosen because they are among the most common cancer types, generally break down along gender lines and involve people of different age groups following different decision paradigms. As part of its information-seeking effort, Sloan Kettering also has conducted some quantitative research in the form of surveys and has held focus groups. Although the sharp differences in the male and female approaches to decision-making were somewhat unexpected, Meehan suspects that they may be the result of the different timelines and treatment consequences inherent in each of these types of cancer. “Men feel they have more time to gather information,” she says. “And they are grappling with how treatment is going to affect body and sexual functioning, as well as their self-identity. They are dealing with a very profound set of decisions.” Jim Kiefert, 77, a long-time prostate cancer survivor who has run faceto- face support groups in Olympia, Washington, for the past 14 years and is a member of Us Too, an online community, agrees with the study’s findings. “The side effects make men especially analytical,” he says. “Young men tend to worry about their sex life, older men worry about incontinence. Either way, these are major quality-of-life issues.” In Kiefert’s experience, only about 10 percent of the men he encounters respond quickly and emotionally. “They want to hurry up and get the cancer out,” says Kiefert. “After completing treatment, they come online to figure out how to deal with its side effects.” John P. Mulhall, a urologist who directs the sexual and reproductive medicine team at Sloan Kettering, says that in his experience, the men who tend to use online forums “are either happy with their outcomes and want to help others or so miserable that they’re starving for information from anywhere.” Mulhall feels that those patients in the middle range, who are reasonably happy with their care and outcomes, tend to visit those sites less frequently. As far as the analytical versus emotional question goes, Mulhall says that he sees both approaches to decision-making in his practice. “Men don’t like to portray their weaknesses, but I have had 50-year-old men with a diagnosis of prostate cancer with tears in their eyes, struggling to make the best possible decision.” Julie Lanahan, a 43-year-old breast cancer survivor from Timonium, Maryland, fits the profile identified by the study. She found her tumor while nursing her fourth child. “I looked to message boards for information, but I knew even before I found out the details about my tumor that I wanted to have a double mastectomy,” recalls Lanahan, who was diagnosed when she was 38. “I wanted to be done with breast cancer.” For most women, double mastectomy does not improve survival compared to less aggressive surgery, but does require additional surveillance and the possibility of more surgery. Yet patient preference is also an important part of breast cancer treatment, and Lanahan considered double mastectomy the best strategy for fighting her stage 2B tumor, which was HER2-, estrogen receptor- and progesterone receptor-positive. Her goal was to definitively put breast cancer behind her. After her surgery, Lanahan had chemotherapy, radiation and treatment with Herceptin for a year. She currently takes tamifoxen, standard-of-care treatment for many women with estrogen receptor-positive tumors.