Abstract
Simple SummaryOlder women with ovarian cancer often receive less anti-cancer treatment than younger women despite evidence showing they may benefit from similar levels of treatment. Little is known, however, about older women’s preferences toward chemotherapy and treatment experience. We aimed to understand the lived experience of older women with ovarian cancer undergoing chemotherapy though interviews and focus groups. Participants expressed a strong desire to undergo full treatment to improve survival for themselves and for their families. Women did not see their age as a reason to have less intensive treatment. Despite feeling overwhelmed with information and daily tasks due to fatigue, participants did not want cancer to interfere with their daily lives. Women felt distressed by logistical issues with transportation and communication between healthcare providers; however, they still felt positive about their care experience and desire for treatment. Older women may benefit from additional help to support effective communication around treatment preferences.Older women with ovarian cancer more often receive less intensive treatment and early discontinuation compared to younger women. There is little understanding of older women’s treatment experience and whether this contributes to declining intensive treatment. We aimed to explore the lived experience of older patients with advanced ovarian cancer undergoing chemotherapy, their treatment preferences and treatment burden. We conducted a phenomenological qualitative study with 15 women who had completed at least three cycles of first-line chemotherapy for advanced epithelial ovarian cancer, aged 65 years or older at the first cycle, at one tertiary cancer centre. We conducted interviews and focus groups and analysed the transcripts using inductive thematic analysis. Women reported a strong preference for active treatment despite treatment burden and toxicities. Participants undertook treatment to lengthen their lives for themselves and their families. Participants did not see age as a barrier to treatment. Patients expressed determination not to let cancer interfere with daily life. Women felt overwhelmed with information and struggled with daily tasks due to fatigue. Logistical issues, such as transportation and ineffective communication between healthcare providers, caused substantial distress. Despite these logistical burdens and toxicities, participants were positive about their care experience and desire for anticancer treatment. Older women may benefit from additional support to facilitate effective communication during the early stages of treatment.
Highlights
Research has established that older women with ovarian cancer have disproportionately poorer survival outcomes than younger women [1]
Without utilising an objective geriatric assessment, as recently recommended in American Society of Clinical Oncology guidance [7], older patients’ fitness may be underestimated or modifiable risk factors may not be addressed leading to unnecessary under-treatment
To help better understand the treatment preferences and treatment experiences of older women with advanced ovarian cancer undergoing chemotherapy, we explored these topics in a qualitative phenomenological study
Summary
Research has established that older women with ovarian cancer have disproportionately poorer survival outcomes than younger women [1]. Older women receive less intensive treatment which may in part may explain the discrepancy [2,3,4,5]. Without utilising an objective geriatric assessment, as recently recommended in American Society of Clinical Oncology guidance [7], older patients’ fitness may be underestimated or modifiable risk factors may not be addressed leading to unnecessary under-treatment. In these cases, psychological and practical factors, including inherent age bias, may contribute to the provision of less intensive care [8].
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