Adjuvant Chemotherapy in Elderly Women with

1. Adjuvant Chemotherapy in Elderly Women with breast cancer (AChEW): patients’ attitudes towards decision-making Helena Harder1, Rachel Ballinger1, Alistair Ring2, Carolyn Langridge1, Lesley Fallowfield1 1SHORE-C, BSMS, University of Sussex; 2Brighton and Sussex Medical School Background 33% of women with early breast cancer (EBC) in the UK are 70 years or older. Decisions about adjuvant chemotherapy in older women with EBC are often challenging. Data about treatment efficacy and outcomes are limited which complicates decision-making due to the uncertainty about benefits. This qualitative study explored patients’ attitudes and decisions about adjuvant chemotherapy. The study was supported by the NCRI Breast Clinical Studies Group (AChEW-8486) ‘The doctor suggested it. It is a lifeline […] I am lucky to be offered it. I am lucky they are bothering with an old woman like me’ (70 yrs) Methods Data on individual treatment decisions was collected in 24 UK cancer centres and cancer units from women aged ≥ 70 years with EBC between April 2010 and December 2011. Patients who were offered chemotherapy (116/803) were invited to have a structured interview, and to complete questionnaires for quality of life (QoL) and functional ability (IADL) either prior to the start of chemotherapy or within 3 weeks of a decision to decline adjuvant treatment. A qualitative data analysis was performed. Results Sample 95/116 women were eligible and approached for the study; 58 (61%) agreed to participate. Age ranged from 70 to 83 (median:73). The majority was from a white ethnic background (95%) and married (64%). 36% were higher education graduates. At interview, 38 (65.5%) had accepted chemotherapy, 16 (27.5%) declined, and 4 (7%) were undecided about treatment. • Preconceptions about chemotherapy • 73% had family or friends with experience of breast cancer and/or chemotherapy: • Consultation • 65.5% reported that chemotherapy was offered as an option: • Chemotherapy discussion included: risks/side-effects (69%), frequency/duration (60%), agents/administration (40%), benefits and survival (31%), coping (14%), and reference to age (7%) • Communication with physician and explanation of treatment was rated as good (respectively, 81% and 79%): • 95% received written information which was rated as positive (57%), negative (9%), or mixed (23%) • 88% of patients were accompanied by family or friends during the consultation: • 50% contacted other HCPs after the consultation (BC nurses: 62%, GPs:17%, other/mixed: 21%) ‘At my age I know quite a lot, [who had chemotherapy] some with breast cancer’ (71 yrs) ‘It was most certainly offered as an option. “You don’t have to have it” he said and he described the other options I could have’ (72 yrs) Decision-making preference: 22.5% in favour of physician-directed: 58.5% preferred shared decision-making: 19% reported patient-directed preference: ‘I will ask questions but prefer him to make a decision’ (70 yrs) ‘he was extremely kind […] he saw me as a person with a background, he was doing his up most for me to understand the information’ (77 yrs) ‘I like someone to recommend and come up with an answer. I like to share [the decision] I like guidance. I don’t know what’s best’ (72 yrs) ‘daughter came […] it was enormously helpful. She is able to grasp and retain everything that is said, I find that difficult and as I get older it is even more difficult really’ (78 yrs) ‘If the doctor gave good advice and it fits my decision I would go along, but if not… my decision would be final!’ (76 yrs) Factors associated with decision-making Women accepting chemotherapy (n=34): prevent recurrence (50%); treatment was recommended/trust in physician (32%); prolong life expectancy (18.5%); motivation of dependents/family (10.5%); greater survival benefits (8%) Women declining chemotherapy (n=10):side-effects/impact on health (69%); low overall survival benefits (50%); length of treatment (37.5%); treatment was recommended/trust in physician (31%); clear/no spread (25%); and context of support (6%) Conclusions Older women with EBC preferred active involvement in decision-making. Recommendations by physicians played a significant role in accepting or declining treatment. Well-informed decision- making and effective communication between physicians, women and their family members remain therefore important. Acknowledgements: patients and staff of the AChEW recruitment centres, and Roche Products Limited for an unrestricted educational grant.