title: Treatment recommendations for older women with breast cancer: A survey among surgical, radiation and medical oncologists.
abstract: OBJECTIVE
  As older women with breast cancer (BC) are underrepresented in trials, it is often unclear what represents the best treatment option for this patient group. To understand how oncologists approach the management of BC in older patients, we assessed their treatment recommendations.
  
  
  METHODS
  In an online survey, 106 surgical, 37 radiation and 31 medical oncologists provided a treatment recommendation for hypothetical patients aged >70 years. Scenarios included loco-regional therapy with patient age varying at 76 and 84 years; systemic therapy with Karnofsky performance score varying at 90 and 50%; neo-adjuvant therapy; and adjuvant chemotherapy in triple-negative BC.
  
  
  RESULTS
  Participants would less often recommend breast-conserving surgery plus radiotherapy for an 84 versus a 76-year-old patient (56% versus 73%, p = 0.001). They would more often accept omission of radiotherapy after breast-conserving surgery in older than in younger patients, if the patient wished to avoid this therapy (26% versus 4%, p < 0.001). All participants would propose systemic therapy for a high-recurrence risk patient with a good performance score, and 92% would still recommend therapy if the patient had a poor score (p < 0.001). Neo-adjuvant hormonal therapy followed by breast-conserving surgery for a large tumour was recommended by 27% of the participants. Adjuvant chemotherapy for an otherwise healthy woman with triple-negative BC was considered by 83% of the participants.
  
  
  CONCLUSIONS
  Patient age and performance status influenced specialists' treatment recommendations. The observed recommendations for the treatment scenarios under investigation differ from older women's actual treatment. This discrepancy highlights the need for studies specifically targeting older patients.
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: V C
authors.initials: VC
authors.lastname: Hamelinck
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: C J H
authors.initials: CJH
authors.lastname: van de Velde
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: G-J
authors.initials: GJ
authors.lastname: Liefers
authors.affiliation: Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands; Department of Gerontology & Geriatrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. Electronic address: e.bastiaannet@lumc.nl.
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D015412:Mastectomy, Segmental; D008495:Medical Oncology; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology; D011878:Radiotherapy; D000071077:Surgical Oncology; D011795:Surveys and Questionnaires; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Geriatric oncology; Physician preference; Treatment decision-making