Preferences of older breast cancer patients linked to chemotherapy rate
MedWire News: A strong preference for chemotherapy and good patient-physician communication are associated with higher rates of chemotherapy use in older women with breast cancer, US research shows.
"Breast cancer chemotherapy decisions in patients aged 65 years and over are complex because of comorbidity, toxicity, and limited data on patient preference," note Jeanne Mandelblatt (Lombardi Comprehensive Cancer Center, Washington, DC) and colleagues.
To examine relationships between patient preferences and chemotherapy use, Mandelblatt and team recruited 801 women aged 65 years and older with invasive, nonmetastatic breast cancer. They collected data from patient interviews, patient charts, and physician surveys.
The researchers report that 69% of patients with a definite indication for chemotherapy (estrogen receptor [ER]-negative and/or node positive breast cancer) received chemotherapy, compared with 16% of patients with a possible indication for chemotherapy (ER-positive and node negative disease).
When women were asked hypothetically about their preference for chemotherapy, 45% indicated that they would choose chemotherapy if it provided up to 12 months of life extension. These women were considered to have a high preference for chemotherapy and were compared with the remaining women who had a lower preference.
Mandelblatt and team found that women with a high preference for chemotherapy were 3.9 times more likely to receive chemotherapy than women with lower preferences. This effect was greater among women with a definite indication for chemotherapy (odds ratio [OR]=7.7), but lower when treatment was possibly indicated (OR=1.9).
For patients for whom chemotherapy was possibly indicated, higher ratings of physician-patient communication were an important determinant of chemotherapy use. Each 5-point increase in communication score was associated with a 1.9-fold increase in the likelihood for chemotherapy.
In addition, patients who were accompanied to physician appointments were twice as likely to receive chemotherapy than those attending alone.
"Older women's preferences and communication with providers are important correlates of chemotherapy use, especially when benefits are more equivocal," write Mandelblatt and co-authors in the Journal of Clinical Oncology.
"These results suggest that physicians can enhance the care of the growing population of older patients with breast cancer through assessment of and communication about chemotherapy risks and benefits, and consideration of women's preferences," they conclude.
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By Laura Dean