Web Tool Provides Individually Tailored Outcome Estimates for Women with DCIS

A group of researchers used outcomes data from a disease simulation model to create a web-based decision tool to aid clinicians and patients in treatment decisions for women diagnosed with ductal carcinoma in situ (DCIS). The tool, onlineDeCISion.org, provides clinicians with tailored information about a patient’s recurrence risk and survival outcomes for each current standard treatment strategy for DCIS: lumpectomy alone, lumpectomy with radiation therapy, lumpectomy with tamoxifen, lumpectomy with radiation and tamoxifen, and mastectomy.

“A decision aid that can be used by clinicians to help educate and inform women about the individual risks associated with DCIS is likely to improve patient decision-making and related outcomes,” the researchers wrote in their paper, which was published in the November issue of Breast Cancer Research and Treatment. “This tool is a significant addition to the field, as no other decision aid exists to provide these data to clinicians or their patients.”

Researchers developed the tool using semi-structured interviews and usability testing with a diverse group of physicians from different locations and practice settings as well as a patient advocate from the Dana-Farber Cancer Center. The process identified several features deemed to be important by users and creators, which are included in the final version: 

• descriptions of current DCIS treatment options;

• visual projections of the likelihood of 10-year and lifetime outcomes for breast preservation, recurrence, and survival; and 

• side-by-side comparisons of down-stream effects for each treatment choice.

The tool also factors in additional health issues the patient may have, allowing clinicians to enter either the patient’s real age or the patient’s physiologic age. Factoring in the presence of comorbidities, the researchers noted, allows for a more realistic expectation of the benefits a treatment may hold for the patient.

Although the tool is targeted to clinicians, the researchers expect it will be used in shared decision-making involving clinicians and their patients. The high level of patient engagement in breast cancer treatment decisions as well as the tendency for individual patients to have strong treatment preferences makes the evidence-based decision aid a wellsuited addition to the field of breast cancer. 

“The majority of physicians caring for patients with DCIS note that treatment decision-making is very complex for these patients and that the emotional distress experienced with a diagnosis of DCIS is very high,” they wrote. “Our web-enabled decision aid, onlineDeCISion.org, displays tailored outcomes following different treatment strategies for DCIS, so that patients can be better informed about the range of treatments available to them and select that treatment most consonant with their own personal preferences, improving the quality of decision making for DCIS.”

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Ozanne EM, Schneider KH, Soeteman D, et al. onlineDeCISion.org: a web-based decision aid for DCIS treatment. Breast Canc Res and Treatment. 2015;154: 181-190.