title: The decision-making process for senior cancer patients: treatment allocation of older women with operable breast cancer in the UK.
abstract: OBJECTIVE
  Up to 40% of women over 70 years with primary operable breast cancer in the UK are treated with primary endocrine therapy (PET) as an alternative to surgery. A variety of factors are important in determining treatment for older breast cancer patients. This study aimed to identify the patient and tumor factors associated with treatment allocation in this population.
  
  
  METHODS
  Prospectively collected data on treatment received (surgery vs. PET) were analysed with multivariable logistic regression using the variables age, modified Charlson Comorbidity Index (CCI), activities of daily living (ADL) score, Mini-Mental State Examination (MMSE) score, HER2 status, tumour size, grade and nodal status.
  
  
  RESULTS
  Data were available for 1,122 cancers in 1,098 patients recruited between February 2013 and June 2015 from 51 UK hospitals. About 78% of the population were treated surgically, with the remainder being treated with PET. Increasing patient age at diagnosis, increasing CCI score, large tumor size (5 cm or more) and dependence in one or more ADL categories were all strongly associated with non-surgical treatment (P<0.05).
  
  
  CONCLUSIONS
  Increasing comorbidity, large tumor size and reduced functional ability are associated with reduced likelihood of surgical treatment of breast cancer in older patients. However, age itself remains a significant factor for non-surgical treatment; reinforcing the need for evidence-based guidelines.
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Morgan
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Richards
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Osama
authors.initials: O
authors.lastname: Zaman
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Ward
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Kwok-Leung
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Audisio
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Malcolm W
authors.initials: MW
authors.lastname: Reed
authors.affiliation: 1 Academic Unit of Surgical Oncology, University of Sheffield Medical School, Sheffield S10 2RX, UK ; 2 Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK ; 3 Center for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield S10 2BP, UK ; 4 Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK ; 5 School of Medicine, University of Nottingham, Royal Derby Hospital Center, Derby DE22 3DT, UK ; 6 Department of Surgery, University of Liverpool, St Helens Teaching Hospital, St Helens WA9 3DA, UK ; 7 Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK.
authors.forename: Lynda
authors.initials: L
authors.lastname: Wyld
keywords: Frail elderly; breast neoplasms; decision-making