title: A Prospective Comparison of Younger and Older Patients' Preferences for Adjuvant Chemotherapy and Hormonal Therapy in Early Breast Cancer.
abstract: It is unknown what minimal benefit in disease-free survival older patients with breast cancer require from adjuvant systemic therapy, and if this differs from that required by younger patients. We prospectively examined patients' preferences for adjuvant chemotherapy (aCT) and adjuvant hormonal therapy (aHT), factors related to minimally-required benefit, and patients' self-reported motivations.
  
  
  
  Fifty-two younger (40-64 years) and 29 older (≥ 65 years) women with a first primary, invasive tumor were interviewed post-surgery, prior to receiving aCT/aHT recommendation.
  
  
  
  The proportions of younger versus older participants who would accept, refuse, or were undecided about therapy were 92% versus 62%, 4% versus 24%, and 4% versus 14% for aCT, and 92% versus 59%, 8% versus 17%, and 0% versus 24% for aHT. The proportion of older participants who would refuse rather than accept aCT was larger than that of younger participants (P = .005). No significant difference was found for aHT (P = .12). Younger and older participants' minimally-required benefit, in terms of additional 10-year disease-free survival, to accept aCT (median, 5% vs. 4%; P = .13) or aHT (median, 10% vs. 8%; P = .15) did not differ. Being single/divorced/widowed (odds ratio [OR], 0.16; P = .005), presence of geriatric condition (inability to perform daily activities, incontinence, severe sensory impairment, depression, polypharmacy, difficulties with walking; OR, 0.27; P = .047), and having a preference to make the treatment decision either alone or after considering the clinician's opinion (active role; OR, 0.15; P = .012) were independently related to requiring larger benefits from aCT. The most frequent motivations for/against therapy included the wish to survive/avoid recurrence, clinician's recommendation, side effects, and treatment duration (only aHT).
  
  
  
  Whereas older participants were less willing to accept aCT than younger participants, no significant difference was found for aHT. However, a majority of older participants would still accept both therapies. Adjuvant systemic therapy should be discussed with eligible patients regardless of age.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Hamelinck
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nienke A
authors.initials: NA
authors.lastname: de Glas
authors.affiliation: Department of Medical Oncology, Haga Hospital, The Hague, The Netherlands.
authors.forename: Johanneke E A
authors.initials: JE
authors.lastname: Portielje
authors.affiliation: Department of Surgery, Haga Hospital, The Hague, The Netherlands.
authors.forename: Jos W S
authors.initials: JW
authors.lastname: Merkus
authors.affiliation: Department of Surgery, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Irma D M
authors.initials: ID
authors.lastname: den Hoed
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gerrit-Jan
authors.initials: GJ
authors.lastname: Liefers
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D009367:Neoplasm Staging; D057240:Patient Preference / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D057566:Self Report
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Adjuvant therapy; Aged; Patient values; Shared decision-making; Treatment preference