Purpose: Many studies demonstrate that women aged 80+ do not receive as aggressive treatment for breast cancer as younger women, yet few studies have examined older women’s decision-making.
Methods: We performed a retrospective cohort study using the online medical record at one large academic medical center and two community health centers in Boston to examine older women’s decision-making after a breast cancer diagnosis. We identified 47 women aged 80+ who were newly diagnosed with breast cancer between 1994-2004 and we followed these women through 12/07. We examined mode of detection, tumor characteristics, treatments recommended and received, patient preferences, course of disease, and comorbidities. We defined standard treatment as receiving mastectomy/ lumpectomy and radiotherapy, and hormonal therapy (HT) for estrogen receptor (ER) positive early stage tumors. Data on death were confirmed using the National Death Index.
Results: Median age of the 47 women was 84 years (range 80-95) and median follow up since diagnosis was 4 years. Sixteen of the tumors were detected by screening mammography, 11 by physician exam, and in 20 cases the patient presented with symptoms. Thirty-nine women had invasive cancer and 8 had Ductal Carcinoma in Situ (DCIS). Of the 39 invasive tumors, 35 (90%) were ER positive (1 was mucinous, 3 were ER negative), 29 (74%) were <2 cm. Nine of the 39 (23%) received standard treatment. Sixteen women (41%) refused at least one standard treatment (9 refused XRT, 4 refused HT, and 3 refused surgery). Reasons for refusals included age, comorbidity, fear of side effects, and preserving quality of life. Physicians did not recommend a standard treatment in 7 cases (18%); 6 due to comorbidity and 1 due to age. In 2 cases patient and doctor decided together against a standard treatment and in 2 cases acute illness/death prevented standard treatment. Two women with DCIS refused a recommended therapy (1 for surgery and 1 for XRT). Family member involvement in decision-making was documented in 24 cases (51%) and PCP involvement in 30 cases (64%). Of the 47 women, 26 (55%) died by the end of the study; only 3 (6%) died of breast cancer.
Conclusions: The decision not to treat older women with breast cancer with standard therapies may be based more on patient preference than physician bias.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making