Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians.
OBJECTIVE
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).


CONCLUSIONS
Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal.
Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Washington, DC, USA. mandelbj@georgetown.edu
Jeanne S
JS
Mandelblatt
Vanessa B
VB
Sheppard
Arti
A
Hurria
Gretchen
G
Kimmick
Claudine
C
Isaacs
Kathryn L
KL
Taylor
Alice B
AB
Kornblith
Anne-Michelle
AM
Noone
Gheorghe
G
Luta
Michelle
M
Tallarico
William T
WT
Barry
Lisa
L
Hunegs
Robin
R
Zon
Michael
M
Naughton
Eric
E
Winer
Clifford
C
Hudis
Stephen B
SB
Edge
Harvey Jay
HJ
Cohen
Hyman
H
Muss
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003625:Data Collection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care / Q000379:methods*; D057240:Patient Preference; D010817:Physician-Patient Relations; D012307:Risk Factors