GABRIEL HORTOBAGYI, MD: Over the past fifty years, medicine has gone from a paternalistic system where the older physician with gray hair would tell the patient, "Thou shalt do this," and the patient would pretty much blindly follow that advice. And as our society has become better educated and as individual rights and prerogatives became more important for all of us, that system had to change and has changed.
ANN PARTRIDGE, MD, MPH: The majority of women in at least the Western cultures these days prefer to have collaborative decision-making. To have a team of physicians who help her to make the best decision that's consonant and most consistent with her values.
ANNOUNCER: This ability to contribute to the decision-making process can impact a patient's treatment experience.
ANN PARTRIDGE, MD, MPH: We've seen, in research, that when women are able to have the amount of input in their breast cancer decisions about treatment and about survivorship issues that they want, they're more satisfied than women who perceive that they had less than the amount of input that they would have desired. If the amount of input matches with what they wanted, then people tend to be happier in the long run.
ANNOUNCER: To prepare for this collaborative process patients may consult educational resources.
JOYCE O'SHAUGHNESSY, MD: The best book, I think, out there is Dr. Susan Love's breast cancer book. She updates it every couple of years. It's very factual and very well done.
ANNOUNCER: Websites also can provide useful information.
GABRIEL HORTOBAGYI, MD: One is a website called People Living with Cancer that is supported by the American Society of Clinical Oncology. And that is put together by a very large group of experts of various specialties, including patient survivors and advocates who have a major focus on this.
ANN PARTRIDGE, MD, MPH: Websites that I would recommend in general are the National Cancer Institute's website, which one can look up on the web. I often recommend that people look to see what's available at their own cancer institute.
ANNOUNCE: Many breast cancer treatment centers have their own websites.
JOYCE O'SHAUGHNESSY, MD: I think on the web, the Susan G. Komen Foundation is an excellent source. Dr. Susan Love has a website that's excellent.
ANN PARTRIDGE, MD, MPH: I also recommend people look at the American Cancer Society online as well as various interest groups such as young women with breast cancer may look to something called the Young Survival Coalition.
STEPHANIE VANGSNESS, RD: Specific to breast cancer and nutrition, I think cancerrd.com; it's a dietician who's actually herself a three-time cancer survivor. And also cancernutritioninfo.com. They provide probably the most comprehensive information, but also the most easily accessible information for the most common questions that women facing breast cancer have.
ANNOUNCER: Not only is the collaborative decision-making process between a patient and her doctors important, collaboration is also key for the multidisciplinary team of specialists providing her care.
ERIC WINER, MD: There are many, many situations in which you need two or three or four different individuals talking about what the most appropriate management is, how best to serve the patient, how to sequence different treatments, and there's nothing that replaces having a team where those people know each other and can work well together.
ANN PARTRIDGE, MD, MPH: A given patient may see a nurse who helps to give her chemotherapy, if she's receiving that; a nurse who helps to educate her more about her disease; physicians such as a medical oncologist or a radiation oncologist; and generally a surgeon who are going help her to make the decisions and do the actual procedures to take care of her disease; and then we often include social workers to help with the psychosocial aspects of a diagnosis of breast cancer; nutritionists to help deal with the changes that one might want to make in their diet, in their lifestyle, once they've been diagnosed with a breast cancer and for help in prevention of future problems; as well as with people like genetics counselors.
ERIC WINER, MD: I don't know that we have data that specifically speaks to this issue or says that a woman who gets multidisciplinary care lives longer or lives better. But I do believe that if a woman is cared for by doctors who are very knowledgeable about breast cancer and communicate with each other and listen to the patient and try to understand what she needs, that that woman will do better.