A Prospective Comparison of Younger and Older Patients' Preferences for Adjuvant Chemotherapy and Hormonal Therapy in Early Breast Cancer.

Autor: Hamelinck VC; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands., Bastiaannet E; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands., Pieterse AH; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands., de Glas NA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Portielje JE; Department of Medical Oncology, Haga Hospital, The Hague, The Netherlands., Merkus JW; Department of Surgery, Haga Hospital, The Hague, The Netherlands., den Hoed ID; Department of Surgery, TweeSteden Hospital, Tilburg, The Netherlands., van de Velde CJ; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Liefers GJ; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Stiggelbout AM; Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl.
Jazyk: angličtina
Zdroj: Clinical breast cancer [Clin Breast Cancer] 2016 Oct; Vol. 16 (5), pp. 379-388. Date of Electronic Publication: 2016 Apr 21.
DOI: 10.1016/j.clbc.2016.04.001
Abstrakt: Background: It is unknown what minimal benefit in disease-free survival older patients with breast cancer require from adjuvant systemic therapy, and if this differs from that required by younger patients. We prospectively examined patients' preferences for adjuvant chemotherapy (aCT) and adjuvant hormonal therapy (aHT), factors related to minimally-required benefit, and patients' self-reported motivations.
Patients and Methods: Fifty-two younger (40-64 years) and 29 older (≥ 65 years) women with a first primary, invasive tumor were interviewed post-surgery, prior to receiving aCT/aHT recommendation.
Results: The proportions of younger versus older participants who would accept, refuse, or were undecided about therapy were 92% versus 62%, 4% versus 24%, and 4% versus 14% for aCT, and 92% versus 59%, 8% versus 17%, and 0% versus 24% for aHT. The proportion of older participants who would refuse rather than accept aCT was larger than that of younger participants (P = .005). No significant difference was found for aHT (P = .12). Younger and older participants' minimally-required benefit, in terms of additional 10-year disease-free survival, to accept aCT (median, 5% vs. 4%; P = .13) or aHT (median, 10% vs. 8%; P = .15) did not differ. Being single/divorced/widowed (odds ratio [OR], 0.16; P = .005), presence of geriatric condition (inability to perform daily activities, incontinence, severe sensory impairment, depression, polypharmacy, difficulties with walking; OR, 0.27; P = .047), and having a preference to make the treatment decision either alone or after considering the clinician's opinion (active role; OR, 0.15; P = .012) were independently related to requiring larger benefits from aCT. The most frequent motivations for/against therapy included the wish to survive/avoid recurrence, clinician's recommendation, side effects, and treatment duration (only aHT).
Conclusion: Whereas older participants were less willing to accept aCT than younger participants, no significant difference was found for aHT. However, a majority of older participants would still accept both therapies. Adjuvant systemic therapy should be discussed with eligible patients regardless of age.
(Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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