May 14, 2009 A new study examining treatment decision-making by older women with early stage breast cancer shows that 45 percent of women would choose to get chemotherapy after surgery -- a figure higher than the national average of women getting the additional treatment.
"This was an unexpected finding," says the study's lead investigator, Jeanne Mandelblatt, MD, MPH, associate director for population sciences at GUMC's Lombardi Comprehensive Cancer Center and professor of oncology and medicine at GUMC. "While these numbers are in contrast with the uniformly high use of chemotherapy in younger early-stage breast cancer patients, they suggest that older women are learning more about their disease and may be weighing the risks and benefits more thoroughly."
The study will be presented at the 45th Annual Meeting of the American Society of Clinical Oncology (ASCO) in Orlando May 29 - June 2.
The women in the study were recruited from 53 treatment centers between 2004 and 2008. All were 65 or older and had invasive, non-metastatic breast cancer. Interviews about preferences and other factors were conducted with 818 volunteer participants and clinical data were gathered from their medical charts.
The women were evaluated in two groups: "chemotherapy indicated" and "consider chemotherapy." The patients in the "indicated" group had cancer characteristics that typically respond to chemotherapy (estrogen-receptor negative and/or node positive). The benefit of chemotherapy for patients in the "consider" group were less clear because of their cancer characteristics (estrogen-receptor positive and node negative). Chemotherapy was "indicated" for 47 percent of the study participants and was "considered" for 53 percent of the women.
Seventy (70) percent of those in the "indicated" group chose to receive chemotherapy compared to 17 percent of those in the "consider" group. Overall, 45 percent of the women say they'd be willing to undergo chemotherapy for an increase of 12 months or less in their life expectancy.
"The observation that patients are more likely to choose chemotherapy when the clinical benefit is greatest but to forego it when the benefit is less clear suggests that women are appropriately judging the benefit-to-risk ratio of chemotherapy, and making the right personal decision for themselves," explains Mandelblatt.
The patients for whom chemotherapy's benefit was less clear were more likely to get the additional treatment when they reported a high level of communication with their doctors.
"Lack of clear evidence and concern about chemotherapy side effects may be reasons for these patterns," explains Mandelblatt, who is also a geriatrician. "Our findings suggest that physicians can enhance the care of older breast cancer patients through assessment of and communication about chemotherapy risks and benefits, and consideration of the women's preferences."
Interestingly, the researchers found that patients who were accompanied to oncology visits were more likely to receive chemotherapy than those attending alone.
Mandelblatt explains, "This result was also unexpected and may be related to several factors -- the influence of family, the presence of social support or a greater need for support, help in recording and processing information, or the influence of a third person on the interaction."
"Relatively little is known about how older women make decisions about commonly recommended chemotherapy. The need to understand patient-decision making is greatest now because the number of older women developing breast cancer is increasing as the Baby Boomer population ages," Mandelblatt concludes.
The study was conducted by researchers in the Cancer and Leukemia Group B (CALGB), an NCI-funded cooperative research group. The study was funded by the NCI and CALGB and a small grant from Amgen Pharmaceuticals for help in patient recruitment. Mandelblatt reports no related financial interests.
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