title: Older women's experience with breast cancer treatment decisions.
abstract: The purpose of this study was to better understand older women's experience with breast cancer treatment decisions. We conducted a longitudinal study of non-demented, English-speaking women ≥ 65 years recruited from three Boston-based breast imaging centers. We interviewed women at the time of breast biopsy (before they knew their results) and 6 months later. At baseline, we assessed intention to accept different breast cancer treatments, sociodemographic, and health characteristics. At follow-up, we asked women about their involvement in treatment decisions, to describe how they chose a treatment, and influencing factors. We assessed tumor characteristics through chart abstraction. We used quantitative and qualitative analyses. Seventy women (43 ≥ 75 years) completed both interviews and were diagnosed with breast cancer; 91 % were non-Hispanic white. At baseline, women 75+ were less likely than women 65-74 to report that they would accept surgery and/or take a medication for ≥ 5 years if recommended for breast disease. Women 75+ were ultimately less likely to receive hormonal therapy for estrogen receptor positive tumors than women 65-74. Women 75+ asked their surgeons fewer questions about their treatment options and were less likely to seek information from other sources. A surgeon's recommendation was the most influential factor affecting older women's treatment decisions. In open-ended comments, 17 women reported having no perceived choice about treatment and 42 stated they simply followed their physician's recommendation for at least one treatment choice. In conclusion, to improve care of older women with breast cancer, interventions are needed to increase their engagement in treatment decision-making.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 1309 Beacon, Office 219, Brookline, Boston, MA, 02446, USA, mschonbe@bidmc.harvard.edu.
authors.forename: Mara A
authors.initials: MA
authors.lastname: Schonberg
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Birdwell
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Bychkovsky
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hintz
authors.forename: Valerie
authors.initials: V
authors.lastname: Fein-Zachary
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wertheimer
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires