Factors Noted to Affect Breast Cancer Treatment Decisions of Women Aged 80 and Older

Authors

  • Mara A. Schonberg MD, MPH,

    Corresponding author
    • Department of Medicine, Beth Israel Deaconess Medical Center, Division of General Medicine and Primary Care, Harvard Medical School
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  • Rebecca A. Silliman MD, PhD,

    1. Section of Geriatrics, Schools of Medicine and Public Health, Boston University, Boston Medical Center, Boston, Massachusetts
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  • Ellen P. McCarthy PhD, MPH,

    1. Department of Medicine, Beth Israel Deaconess Medical Center, Division of General Medicine and Primary Care, Harvard Medical School
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  • Edward R. Marcantonio MD, SM

    1. Department of Medicine, Beth Israel Deaconess Medical Center, Division of General Medicine and Primary Care, Harvard Medical School
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Address correspondence to Mara A. Schonberg, Beth Israel Deaconess Medical Center, 1309 Beacon, Office 202, Brookline, MA 02446. E-mail: mschonbe@bidmc.harvard.edu

Abstract

Objectives

To identify factors that influence the breast cancer treatment decisions of women aged 80 and older.

Design

Medical record review.

Setting

One academic primary care clinic and two community health centers in Boston.

Participants

Sixty-five women aged 80 and older diagnosed with breast cancer between 1994 and 2004 and followed through June 30, 2010.

Measurements

Data were abstracted on breast cancer characteristics, comorbidities, treatments received, and outcomes. Notes from primary care physicians, oncologists, and breast surgeons were reviewed to determine factors involved in treatment decision-making.

Results

Median age at diagnosis was 84.0 (interquartile range 82.0–86.3), 55 (84.6%) were non-Hispanic white, and 40 (61.5%) had at least one comorbidity. Nine women were diagnosed with ductal carcinoma in situ, 42 with a new primary invasive breast cancer, eight with a second primary, and six with a breast cancer recurrence. Sixty-three (96.9%) received some type of treatment. Fifty-six (86.2%) had at least one detailed physician note on treatment decision-making in their charts. The main categories found to influence participant, family, and physician treatment decision-making were tumor characteristics, ratio of treatment benefits to risks, logistics (e.g., transportation, finances), and participant age, health (including a concurrent diagnosis), and psychosocial characteristics. Family was involved in treatment discussions for 46 (70.8%) participants.

Conclusion

The quality of physician documentation about decision-making in these women was high. A great amount of thoughtful and complex decision-making involving patients, family, and physicians occurs after a woman aged 80 and older is diagnosed with breast cancer.

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