Management of Breast Cancer in Older Women: Factors which Influence Patients` Decision§

ABSTRACT

Background: Most studies on cancer patient preferences and information needs have not focused specifically on elderly breast cancer patients. Objective: To determine factors which are taken into account by elderly breast cancer patients ( > 70 years of age) when deciding between primary endocrine therapy or surgery and between mastectomy or wide local excision. Methods: Cross-sectional study of 34 female breast cancer patients who were at least 70 years of age at the time of diagnosis. Structured interviews were conducted either after a follow-up clinic appointment or at home via a telephone interview. Results: Seventy-six per cent of patients were given a choice of treatment and the patients who felt that they were not given a choice did not prefer to choose. Forty-two per cent of patients chose primary endocrine therapy based on the surgeon's recommendation. The same proportion reported that they were afraid of surgery. A quarter wanted to try tablets first and were prepared to undergo surgery if unresponsive. All patients who chose a modified radical mastectomy +/- axillary node clearance or sampling felt that it was safer and wanted to avoid the possibility of further surgery. All patients were satisfied with the amount of information provided and emphasized that the service provided by breast care nurses was invaluable. Conclusion: Not all patients based their decision on the surgeon's recommendation. Some patients were not given any recommendation. Individual preferences of patients should be determined and the management plan should be tailored accordingly.