Breast Cancer Adjuvant Chemotherapy Decisions in Older Women: The Role of Patient Preference and Interactions With Physicians
Year: 2010
Type: article
Study design: Observational Study
Abstract: PURPOSE: Breast cancer chemotherapy decisions in patients > or = 65 years old (older) are complex because of comorbidity, toxicity, and limited data on patient preference. We examined relationships between preferences and chemotherapy use. METHODS: Older women (n = 934) diagnosed with invasive (> or = 1 cm), nonmetastatic breast cancer from 2004 to 2008 were recruited from 53 cooperative group sites. Data were collected from patient interviews (87% complete), physician survey (93% complete), and charts. Logistic regression and multiple imputation methods were used to assess associations between chemotherapy and independent variables. Chemotherapy use was also evaluated according to the following two groups: indicated (estrogen receptor [ER] negative and/or node positive) and possibly indicated (ER positive and node negative). RESULTS: Mean patient age was 73 years (range, 65 to 100 years). Unadjusted chemotherapy rates were 69% in the indicated group and 16% in the possibly indicated group. Women who would choose chemotherapy for an increase in survival of < or = 12 months had 3.9 times (95% CI, 2.4 to 6.3 times; P < .001) higher odds of receiving chemotherapy than women with lower preferences, controlling for covariates. Stronger preferences were seen when chemotherapy could be indicated (odds ratio [OR] = 7.7; 95% CI, 3.8 to 16; P < .001) than when treatment might be possibly indicated (OR = 1.9; 95% CI, 1.0 to 3.8; P = .06). Higher patient rating of provider communication was also related to chemotherapy use in the possibly indicated group (OR = 1.9 per 5-point increase in communication score; 95% CI, 1.4 to 2.8; P < .001) but not in the indicated group (P = .15). CONCLUSION: Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal.
Source: Journal of Clinical Oncology
Authors: Jeanne S. Mandelblatt, Vanessa B. Sheppard, Arti Hurria, Gretchen Kimmick, Claudine Isaacs, Kathryn L. Taylor, Alice B. Kornblith, Anne-Michelle Noone, Gheorghe Luta, Michelle Tallarico, William T. Barry, Lisa Hunegs, Robin Zon, Michael Naughton, Eric Winer, Clifford Hudis, Stephen B. Edge, Harvey Jay Cohen, Hyman Muss
Institutions: Roswell Park Comprehensive Cancer Center, Memorial Sloan Kettering Cancer Center, Georgetown University, Washington University in St. Louis, Dana-Farber Cancer Institute, Duke Medical Center, Northern Indiana Cancer Research Consortium, Georgetown Lombardi Comprehensive Cancer Center, University at Buffalo, State University of New York
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: green
Awards: Cancer and Leukemia Group B Statistical Center, Using Physiological Age to Predict Chemotherapy Toxicity, CHEMOTHERAPY DECISIONS AND OUTCOMES FOR THE ELDERLY, Cancer and Leukemia Group B, Cancer Control at the Intersection of Aging Research, Who Cares For Older Breast Cancer Surivors And How Does It Affect Quality?, Georgetown University Lombardi Comprehensive Cancer Center Support Grant, Duke Claude D. Pepper Older Americans Independence Center
OpenAlex ID: W2102195015