scholarly journals Why do Older Women with Invasive Breast Cancer Avoid Surgery? A Qualitative Analysis of Factors Influencing the Decision of Patients and Physicians

2021 ◽  
Author(s):  
Fernando A. Angarita ◽  
Ethan Hoppe ◽  
Gary Ko ◽  
Justin Lee ◽  
Danny Vesprini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Decision Making ◽  
Older Women ◽  
Invasive Breast Cancer ◽  
Treatment Decision ◽  
Patient Centered ◽  
Treatment Decision Making ◽  
Cancer Specialists

Abstract Purpose: Limited data exists about why older women (≥70 years old) with breast cancer avoid surgery. This study aimed to identify physician- and patient-perceived attitudes that influence the decision to avoid surgery among older women with invasive breast cancer.Methods: Semi-structured in-depth interviews were conducted with multidisciplinary breast cancer specialists and with older women with breast cancer who declined surgery. Transcripts were iteratively coded using a theoretical framework to guide identification of common themes. Thematic comparison was performed between patients and physicians. Results: Ten breast cancer specialists and eleven patients participated. Physicians believed older women declined surgery because they did not perceive their breast cancer as a life-threatening ailment compared to other medical comorbidities. Physicians did not discuss breast reconstruction, as it was perceived to be unimportant. Treatment side effects, length of treatment, impact on quality of life, and minimal survival benefit strongly influenced a patient’s decision to decline surgery. Patients valued independence and quality of life over quantity of life. Patients felt empowered to participate in the decision-making process but appreciated having support. Both groups had congruent beliefs with respect to age impacting treatment decision, cosmesis playing a minor factor in treatment decisions, and importance of quality of life; however, they were discordant in their perceptions about the amount of support that patients have from their families.Conclusion: The decision to avoid surgery in older women stems from a variety of individual beliefs. Acknowledging patient values early in treatment planning may facilitate a patient-centered approach to treatment decision making.

scholarly journals The quality of life index: a pilot study integrating treatment efficacy and quality of life in oncology

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
A. Basu ◽  
E. J. Philip ◽  
B. Dewitt ◽  
J. Hanmer ◽  
A. Chattopadhyay ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Treatment Decision ◽  
Therapeutic Agents ◽  
Patient Centered ◽  
Life Index ◽  
Treatment Decision Making ◽  
Related Quality ◽  
Quality Of Life Index

Abstract The majority of women diagnosed with breast cancer will experience some form of drug-related toxicity and subsequent impairments in Health-related Quality of Life (HRQoL). Despite this, HRQoL is assessed inconsistently and there is no validated method to integrate HRQoL data into the assessment of therapeutic agents. This proof of concept study utilizes data from the neoadjuvant I-SPY 2 clinical trial to describe the development of the Quality of Life Index (QoLI) measure. The QoLI represents a single composite score that incorporates validated longitudinal measures of clinical efficacy and QoL and one that permits a more comprehensive, direct comparison of individual therapeutic agents. Preliminary data suggest the QoLI is able to distinguish between agents based on their efficacy and toxicity; with further validation, the QoLI has the potential to provide more patient-centered evaluations in clinical trials and help guide treatment decision making in breast cancer and other oncologic diseases.

scholarly journals AN OVERVIEW OF THE NOTTINGHAM RESEARCH PROGRAMME ON PRIMARY BREAST CANCER IN OLDER WOMEN

2021 ◽  
Vol 3 (3) ◽  
pp. 49-52
Author(s):  
Ruth Parks ◽  
Kwok-Leung Cheung
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Older Women ◽  
Geriatric Assessment ◽  
Primary Breast Cancer ◽  
Treatment Decision ◽  
Research Programme ◽  
Complex Needs ◽  
Treatment Decision Making

The incidence of breast cancer increases with age. Despite this, most research in this field is aimed at the younger patient. Preliminary studies have shown that older women with breast cancer have distinct biological features compared to their younger counterparts. In addition, the focus of treatment of older women may not simply be curative but may be a trade-off between risks of treatment and impact on independence and quality of life. The Nottingham research programme is a unique programme dedicated to primary breast cancer in older women. There are two arms of the research programme 1) determining the biological differences of breast cancer in this cohort 2) exploring the use of geriatric assessment to understand the complex needs and factors contributing to treatment decision making in this group of patients. The overall aim of the research programme is to optimise both the biological and geriatric assessment of older women with primary breast cancer, to provide personalised data at diagnosis, on likely survival and quality of life outcomes following breast cancer treatment. This article will outline why this research programme is important, what it has achieved so far and future aspirations.

HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-089
Author(s):  
Sara Hayes ◽  
Brian M. Green ◽  
Shayna Yeates ◽  
Amrita Bhowmick ◽  
Kaitlyn McNamara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Cancer Care ◽  
Hospice Care ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making ◽  
Diagnosis Of Cancer

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.

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