Abstract
BackgroundThere are few comprehensive reviews of breast cancer outcomes in older women. We synthesize data to describe key findings and gaps in knowledge about the outcomes of breast cancer in this population.MethodsWe reviewed research published between 1995 and June 2003 on breast cancer quality of life and outcomes among women aged 65 and older treated for breast cancer. Outcomes included communication, satisfaction, and multiple quality of life domains.ResultsFew randomized trials or cohort studies that measured quality of life after treatment focused exclusively on older women. Studies from older women generally noted that, with the exception of axillary dissection, type of surgical treatment generally had no effect on long-term outcomes. In contrast, the processes of care, such as choosing therapy, good patient-physician communication, receiving treatment concordant with preferences about body image, and low perceptions of bias, were associated with better quality of life and satisfaction.ConclusionsWith the exception of axillary dissection, the processes of care, and not the therapy itself, seem to be the most important determinants of long-term quality of life in older women.
Highlights
Breast cancer is an important disease and one where health care services have the potential to improve the quality and quantity of life
It should be noted that most observational studies to date have only examined short-term side effects and symptoms of treatment and future research is need on long-term side effects of treatments in older breast cancer survivors
80% of older women indicated that chemotherapy would be worthwhile if they could live an additional two years,[37] but others have found that women in this age group would accept aggressive chemotherapy for as little as a 1% increase in survival [38,39]. These results suggest that older women are willing to trade-off shortterm physical well-being, such as occurs with chemotherapy, for increased survival
Summary
Few randomized trials or cohort studies measured quality of life after treatment and focused exclusively on older women [12,13,14]. Receipt of chemotherapy (yes vs no) has not been related to any long-term mental health outcomes except for having a perception that breast cancer had a greater impact on one's life, even after considering stage and other factors [13]. One aspect of this negative impact has been distress about weight gain associated with chemotherapy [66]. Exclusion of older women with multiple comorbidities from clinical trials may result in less representative samples of breast cancer patients and interfere with improving understanding of the impact that such conditions have on quality of life. Additional research is needed to understand dynamic interactions between cancer survivorship, comorbidities, aging per se, poverty, ethnicity, and the processes of interaction with the medical care system in producing the observed outcomes of care
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