A pilot study exploring issues around decision making in older women with primary operable breast cancer.

Abstract

e20588 Background: Decision making process related to cancer treatment is complex, influenced by tumour factors, patients and clinicians, and may affect outcomes eg quality of life (QOL). Studies are scarce in exploring this subject in the older population. This pilot study aimed to investigate this in older (≥70 years) women newly diagnosed with clinically T0-2N0-1M0 breast cancer. Methods: Patients as described were invited to participate. Actual treatment planning was made by the clinical team and was not part of the study. Semi-structured interviews were conducted within 6 weeks and at 6 months, alongside Comprehensive Geriatric Assessment (CGA) and QOL assessment using EORTC QLQ-C30. Interview recordings were transcribed (intelligent verbatim) and then analysed by (i) identifying themes; and (ii) comparing them with CGA and QOL measures. Results: Forty-one patients took part at the time of analysis. The following themes emerged in different patient combinations, at both time points. 1) Symptoms - The majority presented symptomatically (87%, 21/31). At 6 months, 45% (18/40) reported a negative feeling, but 81% (22/27) said they would choose the same treatment again. 2) Knowledge - Most patients (80%, 28/35) knew someone with a cancer diagnosis, but did not know much about breast cancer or treatment (87%, 18/24). 3) Reactions - At diagnosis, only 48% (10/23) felt ‘shocked’ or ‘surprised,’ while the remainder had ‘no reaction’ or ‘were prepared’. The majority (91%, 29/32) felt that they had received enough information about treatment options or that they did not have an option. 4) QOL - Most patients (88%, 15/17) thought they had made the right treatment choice. The majority (86%, 6/7) were not worried about the future and 91% (10/11) reported no change in QOL. No relationship was seen between these interview findings and the treatment modalities received. These findings were consistent with the results of CGA and QOL assessment. Conclusions: These preliminary findings suggest that these patients were generally happy with the decision made for their treatments and had a fairly good QOL and future outlook. The study has now entered into a second stage where more in-depth interviews are being conducted.