Attitudes towards breast conservation in patients aged over 70 with breast cancer

Abstract

BackgroundThe majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making.MethodsA questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013. This detailed surgical options and recommendations, timing of decision making, treatment expectations, psychological and cosmetic concerns and other factors which may have influenced any decision made e.g. travel for radiotherapy and potential side effects.ResultsResponses were received from 339 patients, 192 of whom had a mastectomy with the remaining undergoing BCS. In the mastectomy group 18 % (35) would have preferred to have BCS had it been an option, with 40 % (76) of group being happy to take neoadjuvant endocrine therapy to try and facilitate this. However, only 14 % (26) of patients would have considered neoadjuvant chemotherapy with the same aim. Almost half (82) of the mastectomy patients said that the risk of local recurrence following BCS was a factor which influenced their decision.ConclusionBCS is something that patients aged over 70 are interested in considering in the same way as younger patients. More than a third of patients requiring mastectomy would be willing to take neoadjuvant endocrine therapy to attempt to downstage their tumour to facilitate BCS.

Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer

“…A study from Australia reported that only 31 of the mastectomy group (47%) felt that they had been given a choice of surgery, whereas this number was significantly higher in the BCS group (n = 55, 62.5%) 19 . A study among older women (>70 years old) who were eligible for either mastectomy or BCS reported that only 26% (n = 50) of women who had a mastectomy recalled they had discussed the possibility of BCS with their surgeons before surgery, and 18% (n = 35) of mastectomy patients said they would have preferred BCS if it had been a treatment option 38 …”

“…More than half of the reviewed studies (n = 16, 55.17%) focused on early breast cancer (stages 0-II) 11,17,19,20,23,26,28,29,31,32,34–36,39,41–43 . Fifteen studies reported the duration from surgery to study enrollment 19–21,23–26,29,31,35,36,38,40,42,44 . The mean duration ranged from 2.43 days to 5 years.…”

“…The mean duration ranged from 2.43 days to 5 years. Five studies included women who had a mastectomy for more than 5 years previously 23,31,38,42,44 …”

“…In the Kirby et al 27 survey, patients were asked to identify which factors from the given list of items influenced their decision of having a mastectomy: “1) they felt safer 2) they wanted to reduce the risk of further surgery 3) they wished to avoid radiotherapy or 4) other reasons.” 27 (p2) Researchers in this study did not report how this survey was developed. Only 5 quantitative studies used study-specific questionnaires when reporting a previous pilot study 18,20,31,38,43 . Six studies adopted standardized instruments: the Control Preference Scale (measuring involvement in decision-making), 11,29 the 16-item Factor List (measuring factors for a surgical choice), 19 the Multidimensional Health Locus of Control Scale (measuring internal and external factors of a health-related behavior), 19 the Choice Influence Scale (measuring reasons for a surgical choice), 21 the Holmes-Rovner Scale (measuring levels of satisfaction with their choice), 22 and the Breast Cancer Decision-Making Questionnaire (measuring factors for a surgical choice) 24 …”

Decision-making about mastectomy among Chinese women with breast cancer: a mixed-methods study protocol

“…Previous randomised control trials have indicated the same survival outcomes after mastectomy and breast-conserving surgery (BCS) 1–3. Thus, many studies have provided insights into women’s choice behaviour between mastectomy and BCS 4–7. Most existing studies have focused on factors influencing surgical choices, while patient involvement, decisional conflict and decision-making experiences are underexplored.…”