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Sheldon Greenfield, MD; Dolores M. Blanco, MPH; Robert M. Elashoff, PhD; Patricia Ganz, MD
UCLA School of Medicine Los Angeles

JAMA. 1987;258(18):2526-2527.

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In Reply.—

We appreciate Dr Shocket's thoughtful questions. We cannot be sure of the patient or family role in rejecting appropriate management. However, this factor is unlikely to have played an important role in the treatment of these patients for two reasons. First, physicians in these hospitals occasionally indicated that patients had refused treatment. Most of these patients had high levels of comorbidity and were omitted because we were studying physician treatment. Second, the primary treatment for breast cancer is not very aggressive in terms of the toxic reactions and the burden to patients. We did not examine chemotherapy or treatment with extensive radiation. Therefore, we would not expect many patients to refuse this level of treatment. We think it is unlikely that patient refusal had any sizable impact on our conclusions.

With respect to the definition of appropriate treatment, Dr Shocket focused on the appropriateness of axillary dissection. The . . . [Full Text PDF of this Article]

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