Racial/ethnicity disparities in invasive breast cancer among younger and older women: An analysis using multiple measures of population health

Abstract Purpose: Limited data exists about why older women (≥70 years old) with breast cancer avoid surgery. This study aimed to identify physician- and patient-perceived attitudes that influence the decision to avoid surgery among older women with invasive breast cancer.Methods: Semi-structured in-depth interviews were conducted with multidisciplinary breast cancer specialists and with older women with breast cancer who declined surgery. Transcripts were iteratively coded using a theoretical framework to guide identification of common themes. Thematic comparison was performed between patients and physicians. Results: Ten breast cancer specialists and eleven patients participated. Physicians believed older women declined surgery because they did not perceive their breast cancer as a life-threatening ailment compared to other medical comorbidities. Physicians did not discuss breast reconstruction, as it was perceived to be unimportant. Treatment side effects, length of treatment, impact on quality of life, and minimal survival benefit strongly influenced a patient’s decision to decline surgery. Patients valued independence and quality of life over quantity of life. Patients felt empowered to participate in the decision-making process but appreciated having support. Both groups had congruent beliefs with respect to age impacting treatment decision, cosmesis playing a minor factor in treatment decisions, and importance of quality of life; however, they were discordant in their perceptions about the amount of support that patients have from their families.Conclusion: The decision to avoid surgery in older women stems from a variety of individual beliefs. Acknowledging patient values early in treatment planning may facilitate a patient-centered approach to treatment decision making.

Download Full-text

Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study

BMJ Open ◽

10.1136/bmjopen-2019-035395 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035395 ◽

Cited By ~ 1

Author(s):

Yasmin Jauhari ◽

Melissa Ruth Gannon ◽

David Dodwell ◽

Kieran Horgan ◽

Karen Clements ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cohort Study ◽

Older Women ◽

Invasive Breast Cancer ◽

Secondary Care ◽

Regression Models ◽

Frailty Index ◽

External Validation ◽

Administrative Records

ObjectivesStudies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer.DesignRetrospective cohort study.ParticipantsWomen aged ≥50 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England.MethodsThe secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell’s c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales.ResultsThe SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50–69, 70–79 and ≥80 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict overall survival. Similar results were obtained when the models were applied to the Welsh cohort (n=4 230).ConclusionThe SCARF index provides a simple and consistent method to identify frailty in population level data and could help describe differences in breast cancer treatments and outcomes.

Download Full-text