Treatment Decision-Making Among Older Women with Breast Cancer

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.

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O.6 Factors that affect counselling and treatment decision making in older women (>70 years) with breast cancer: a qualitative study

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(13)70165-3 ◽

2007 ◽

Vol 64 ◽

pp. S31

Author(s):

L. Husain ◽

K. Collins ◽

L. Wyld ◽

M. Reed

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Qualitative Study ◽

Older Women ◽

Treatment Decision ◽

Treatment Decision Making

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Instrumental Relating and Treatment Decision Making Among Older Women With Early-Stage Breast Cancer

Oncology Nursing Forum ◽

10.1188/12.onf.e10-e19 ◽

2011 ◽

Vol 39 (1) ◽

pp. E10-E19 ◽

Cited By ~ 5

Author(s):

Huibrie C. Pieters ◽

MarySue V. Heilemann ◽

Sally Maliski ◽

Katrina Dornig ◽

Jan Mentes

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Older Women ◽

Early Stage ◽

Treatment Decision ◽

Early Stage Breast Cancer ◽

Treatment Decision Making

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The balance of clinician and patient input into treatment decision-making in older women with operable breast cancer

Psycho-Oncology ◽

10.1002/pon.3853 ◽

2015 ◽

Vol 24 (12) ◽

pp. 1761-1766 ◽

Cited By ~ 9

Author(s):

Jenna L. Morgan ◽

Maria Burton ◽

Karen Collins ◽

Kate J. Lifford ◽

Thompson G. Robinson ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Older Women ◽

Treatment Decision ◽

Operable Breast Cancer ◽

Treatment Decision Making

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Enhancing Involvement in Treatment Decision Making by Women with Breast Cancer

10.21236/ada473376 ◽

2007 ◽

Author(s):

Mary A. O'Brien ◽

Timothy Whelan ◽

Amiram Gafni ◽

Cathy Charles ◽

Peter Ellis

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Treatment Decision ◽

Treatment Decision Making

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Enhancing Involvement in Treatment Decision Making by Women with Breast Cancer

10.21236/ada491137 ◽

2008 ◽

Author(s):

MaryAnn O'Brien

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Treatment Decision ◽

Treatment Decision Making

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Gene Expression Assay in the Management of Early Breast Cancer

Current Medicinal Chemistry ◽

10.2174/0929867326666191205163329 ◽

2020 ◽

Vol 27 (17) ◽

pp. 2826-2839 ◽

Cited By ~ 2

Author(s):

Roberta Caputo ◽

Daniela Cianniello ◽

Antonio Giordano ◽

Michela Piezzo ◽

Maria Riemma ◽

...

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Decision Making ◽

Adjuvant Chemotherapy ◽

Early Breast Cancer ◽

Treatment Decision ◽

Endocrine Treatment ◽

Expression Ratio ◽

Treatment Decision Making ◽

Low Sensitivity

The addition of adjuvant chemotherapy to hormonal therapy is often considered questionable in patients with estrogen receptor-positive early breast cancer. Low risk of disease relapse after endocrine treatment alone and/or a low sensitivity to chemotherapy are reasons behind not all patients benefit from chemotherapy. Most of the patients could be exposed to unnecessary treatment- related adverse events and health care costs when treatment decision-making is based only on classical clinical histological features. Gene expression profile has been developed to refine physician’s decision-making process and to tailor personalized treatment to patients. In particular, these tests are designed to spare patients the side effects of unnecessary treatment, and ensure that adjuvant chemotherapy is correctly recommended to patients with early breast cancer. In this review, we will discuss the main diagnostic tests and their potential clinical applications (Oncotype DX, MammaPrint, PAM50/Prosigna, EndoPredict, MapQuant Dx, IHC4, and Theros-Breast Cancer Gene Expression Ratio Assay).

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