title: Choices in cancer treatment: a qualitative study of the older women's (>70 years) perspective.
abstract: OBJECTIVE
  Primary endocrine therapy (PET) is the treatment of primary, operable breast cancer with drugs, such as tamoxifen, rather than surgery. It is in widespread use in the UK with 40% of women over 70 years old being treated in this way. PET is associated with inferior rates of local control compared with the standard surgical therapies, but there is no difference in overall survival. There has been no published research regarding the attitudes of older women concerning these two alternative approaches to treatment; what may influence their treatment choice or their experience of either treatment modality. This study aimed to address these questions.
  
  
  METHODS
  In-depth qualitative interviews were undertaken to explore the views of a group of 21 purposively selected older women (>70 years old), who had been treated by PET or surgery for breast cancer. The interviews were transcribed verbatim and analysed using Framework Analysis.
  
  
  RESULTS
  Both surgery and PET were well tolerated and had high satisfaction ratings from most women. This was the case even for those who had complications following surgery or needed a change of management in the PET group. Older women expressed no age-specific fears for operative procedures. The women were passive information seekers and relied heavily on 'expert' advice in making their treatment choices. Neither social support or age were factors in their decision-making. Their main concern was to ensure that their quality of life and independence remained unaffected.
  
  
  CONCLUSIONS
  Older women have no strong preference for either treatment option but are concerned that the treatment is effective and causes minimal disruption to their quality of life and independence. This study suggests that medical consultations may need to be adapted to reflect the passive acceptance of 'expert' advice in the majority of women in this age group.
authors.affiliation: Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK.
authors.forename: Lopa Sadia
authors.initials: LS
authors.lastname: Husain
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
authors.forename: Malcolm
authors.initials: M
authors.lastname: Reed
authors.forename: Lynda
authors.initials: L
authors.lastname: Wyld
mesh_terms: D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D002755:Choice Behavior; D003142:Communication; D015897:Comorbidity; D003657:Decision Making; D006801:Humans; D007389:Internal-External Control; D007406:Interview, Psychological; D008197:Lymph Node Excision / Q000523:psychology; D008408:Mastectomy / Q000523:psychology*; D009367:Neoplasm Staging; D010166:Palliative Care / Q000523:psychology; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D011379:Prognosis; D012803:Sick Role; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen