Older women’s experience with breast cancer treatment decisions

Abstract

BACKGROUND There are limited data explaining why women ≥80 years receive less aggressive treatment for breast cancer than younger women. OBJECTIVES To identify factors that influence women aged 80 and older’s breast cancer treatment decisions. DESIGN Medical record review. SETTING One academic primary care clinic and two community health centers in Boston. PARTICIPANTS 65 women aged ≥80 years diagnosed with breast cancer between 1994–2004 and followed through 6/30/2010. MEASUREMENTS We abstracted data on breast cancer characteristics, comorbidities, treatments received, and outcomes. We reviewed notes from primary care physicians, oncologists, and breast surgeons to determine factors involved in treatment decision-making. RESULTS Median age at diagnosis was 84.0 years (interquartile range 82.0–86.3); 84.6% (n=55) were non-Hispanic white; and 61.5% (n=40) had at least one comorbidity. Nine women were diagnosed with ductal carcinoma in situ, 42 with a new primary invasive breast cancer, 8 with a second primary, and 6 with a breast cancer recurrence. Sixty-three (96.9%) received some type of treatment. Fifty-six (86.2%) had at least one detailed physician note on treatment decision-making in their chart. The main categories found to influence patient, family, and physician treatment decision-making were: tumor characteristics, the ratio of treatment benefits to risks, logistics (e.g. transportation, finances), and patient age, health (including a concurrent diagnosis), and psychosocial characteristics. Family was involved in treatment discussions for 46 (70.8%) patients. CONCLUSION The quality of physician documentation about decision-making in these women was quite high. A great deal of thoughtful and complex decision-making involving patients, family, and physicians is noted to occur after a woman ≥80 years is diagnosed with breast cancer.

A Prospective Comparison of Younger and Older Patients' Preferences for Adjuvant Chemotherapy and Hormonal Therapy in Early Breast Cancer

“…These 2 factors have often been noted in previous studies concerning older patients' decisionmaking about aCT 13,14 and about treatment for BC in general. 15,28 Further, our study indicated that motivations against aCT largely differed between younger and older participants. Both groups frequently reported concern about side effects as a motivation.…”

“…8,12 A few studies have retrospectively explored factors that may affect the decisions about adjuvant systemic treatment of older patients with BC. [13][14][15] These studies involved only patients aged 65 to 70 years and over, making it difficult to determine whether older patients place different values on benefits versus side effects of adjuvant systemic therapy than younger patients. To our knowledge, solely 1 retrospective study examined age differences in factors influencing treatment decisions for aCT and aHT.…”

Decision‐support networks of women newly diagnosed with breast cancer

“…Women with larger networks also reported more deliberative surgical treatment decisions, which is a promising outcome, particularly at a time when there is concern that patients may be rushing into making breast cancer treatment decisions. [23][24][25] Our results suggest that engaging DSPs in the treatment decision process may be an important mechanism for slowing these decisions down, potentially allowing patients to more deeply consider them. Our findings confirm prior work demonstrating that most women do not make their breast cancer treatment decisions on their own and, instead, heavily involve other support people in these emotional and difficult decisions.…”

Decision support networks of women newly diagnosed with breast cancer.

“…Women with larger networks also reported more deliberative surgical treatment decisions, a promising outcome particularly at a time where there is concern that patients are rushing into making breast cancer treatment decisions. [23][24][25] Our results suggest that engaging DSPs in the treatment decision process may be an important mechanism for slowing these decisions down, potentially allowing patients to more deeply consider them.…”