Skip to main content

Advertisement

SpringerLink
Log in

Older women’s experience with breast cancer treatment decisions

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The purpose of this study was to better understand older women’s experience with breast cancer treatment decisions. We conducted a longitudinal study of non-demented, English-speaking women ≥ 65 years recruited from three Boston-based breast imaging centers. We interviewed women at the time of breast biopsy (before they knew their results) and 6 months later. At baseline, we assessed intention to accept different breast cancer treatments, sociodemographic, and health characteristics. At follow-up, we asked women about their involvement in treatment decisions, to describe how they chose a treatment, and influencing factors. We assessed tumor characteristics through chart abstraction. We used quantitative and qualitative analyses. Seventy women (43 ≥ 75 years) completed both interviews and were diagnosed with breast cancer; 91 % were non-Hispanic white. At baseline, women 75+ were less likely than women 65–74 to report that they would accept surgery and/or take a medication for ≥ 5 years if recommended for breast disease. Women 75+ were ultimately less likely to receive hormonal therapy for estrogen receptor positive tumors than women 65–74. Women 75+ asked their surgeons fewer questions about their treatment options and were less likely to seek information from other sources. A surgeon’s recommendation was the most influential factor affecting older women’s treatment decisions. In open-ended comments, 17 women reported having no perceived choice about treatment and 42 stated they simply followed their physician’s recommendation for at least one treatment choice. In conclusion, to improve care of older women with breast cancer, interventions are needed to increase their engagement in treatment decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765

    Article  PubMed  Google Scholar 

  2. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr (1999) Albain KS: underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067

    Article  CAS  PubMed  Google Scholar 

  3. Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP (2010) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28(12):2038–2045

    Article  PubMed Central  PubMed  Google Scholar 

  4. Schonberg MA, Marcantonio ER, Ngo L, Silliman RA, McCarthy EP (2012) Does life expectancy affect treatment of women aged 80 and older with early stage breast cancers? J Geriatr Oncol 3(1):8–16

    Article  PubMed Central  PubMed  Google Scholar 

  5. Liang W, Burnett CB, Rowland JH, Meropol NJ, Eggert L, Hwang YT, Silliman RA, Weeks JC, Mandelblatt JS (2002) Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20(4):1008–1016

    Article  PubMed  Google Scholar 

  6. Pieters HC, Heilemann MV, Maliski S, Dornig K, Mentes J (2012) Instrumental relating and treatment decision making among older women with early-stage breast cancer. Oncol Nurs Forum 39(1):E10–E19

    Article  PubMed  Google Scholar 

  7. Beaver K, Luker KA, Owens RG, Leinster SJ, Degner LF, Sloan JA (1996) Treatment decision making in women newly diagnosed with breast cancer. Cancer Nurs 19(1):8–19

    Article  CAS  PubMed  Google Scholar 

  8. Bilodeau BA, Degner LF (1996) Information needs, sources of information, and decisional roles in women with breast cancer. Oncol Nurs Forum 23(4):691–696

    CAS  PubMed  Google Scholar 

  9. Bruera E, Willey JS, Palmer JL, Rosales M (2002) Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer 94(7):2076–2080

    Article  PubMed  Google Scholar 

  10. Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O’Neil J, Bilodeau B, Watson P, Mueller B (1997) Information needs and decisional preferences in women with breast cancer. JAMA 277(18):1485–1492

    Article  CAS  PubMed  Google Scholar 

  11. Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG (2004) Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 22(15):3091–3098

    Article  PubMed  Google Scholar 

  12. Maly RC, Umezawa Y, Leake B, Silliman RA (2004) Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 85(3):201–209

    Article  PubMed  Google Scholar 

  13. Petrisek AC, Laliberte LL, Allen SM, Mor V (1997) The treatment decision-making process: age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer. Gerontologist 37(5):598–608

    Article  CAS  PubMed  Google Scholar 

  14. Presutti R, D’Alimonte L, McGuffin M, Chen H, Chow E, Pignol JP, Di Prospero L, Doherty M, Kiss A, Wong J et al (2013) Decisional support throughout the cancer journey for older women diagnosed with early stage breast cancer: a single institutional study. J Cancer Educ

  15. Hack TF, Degner LF, Watson P, Sinha L (2006) Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psychooncology 15(1):9–19

    Article  PubMed  Google Scholar 

  16. Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Lakhani I, Salem B, Katz SJ (2005) Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res 40(3):745–767

    Article  PubMed Central  PubMed  Google Scholar 

  17. Step MM, Siminoff LA, Rose JH (2009) Differences in oncologist communication across age groups and contributions to adjuvant decision outcomes. J Am Geriatr Soc 57(Suppl 2):S279–S282

    Article  PubMed  Google Scholar 

  18. Schonberg MA, Silliman RA, McCarthy EP, Marcantonio ER (2012) Factors noted to affect breast cancer treatment decisions of women aged 80 and older. J Am Geriatr Soc 60(3):538–544

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50:178–211

    Google Scholar 

  20. Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714

    Article  CAS  PubMed  Google Scholar 

  21. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H (1983) Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry 140(6):734–739

    CAS  PubMed  Google Scholar 

  22. Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER (2011) External validation of an index to predict up to 9 years mortality of community-dwelling adults aged 65 and older. J Am Geriatr Soc 59(8):1444–1451

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rehnberg G, Absetz P, Aro AR (2001) Women’s satisfaction with information at breast biopsy in breast cancer screening. Patient Educ Couns 42(1):1–8

    Article  CAS  PubMed  Google Scholar 

  24. Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG (1990) Patients’ Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care. J Gen Intern Med 5(1):29–33

    Article  CAS  PubMed  Google Scholar 

  25. Mandelblatt J, Kreling B, Figeuriedo M, Feng S (2006) What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 24(30):4908–4913

    Article  PubMed  Google Scholar 

  26. Crabtree F, Miller WL (eds) (1992) Doing qualitative research. Sage, Newbury Park

    Google Scholar 

  27. Denzin NK, Lincoln YS (eds) (2000) Handbook of qualitative research. Sage Publications, Thousand Oaks

    Google Scholar 

  28. Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP (2013) Individualizing cancer screening in older adults: a narrative review and framework for future research. J Gen Intern Med 28(2):292–298

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hughes KS, Schnaper LA, Bellon JR, Cirrincione CT, Berry DA, McCormick B, Muss HB, Smith BL, Hudis CA, Winer EP et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31(19):2382–2387

    Article  CAS  PubMed  Google Scholar 

  30. Soulos PR, Yu JB, Roberts KB, Raldow AC, Herrin J, Long JB, Gross CP (2012) Assessing the impact of a cooperative group trial on breast cancer care in the medicare population. J Clin Oncol 30(14):1601–1607

    Article  PubMed Central  PubMed  Google Scholar 

  31. Buchholz TA (2009) Radiation therapy for early-stage breast cancer after breast-conserving surgery. N Engl J Med 360(1):63–70

    Article  CAS  PubMed  Google Scholar 

  32. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, Correa C, Cutter D, Gagliardi G, Gigante B et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998

    Article  CAS  PubMed  Google Scholar 

  33. Lee CN, Chang Y, Adimorah N, Belkora JK, Moy B, Partridge AH, Ollila DW, Sepucha KR (2012) Decision making about surgery for early-stage breast cancer. J Am Coll Surg 214(1):1–10

    Article  PubMed Central  PubMed  Google Scholar 

  34. Gold HT, Dick AW (2004) Variations in treatment for ductal carcinoma in situ in elderly women. Med Care 42(3):267–275

    Article  PubMed  Google Scholar 

  35. Baxter NN, Virnig BA, Durham SB, Tuttle TM (2004) Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 96(6):443–448

    Article  PubMed  Google Scholar 

  36. Shamliyan T, Wang SY, Virnig BA, Tuttle TM, Kane RL (2010) Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. J Natl Cancer Inst Monogr 2010(41):121–129

    Article  PubMed  Google Scholar 

  37. Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, Gross CP (2006) Effectiveness of radiation therapy in older women with ductal carcinoma in situ. J Natl Cancer Inst 98(18):1302–1310

    Article  PubMed  Google Scholar 

  38. Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA et al (2010) National institutes of health state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ September 22–24, 2009. J Natl Cancer Inst 102(3):161–169

    Article  PubMed  Google Scholar 

  39. Kaplan HG, Malmgren JA, Atwood MK (2013) Adjuvant chemotherapy and differential invasive breast cancer specific survival in elderly women. J Geriatr Oncol 4(2):148–156

    Article  PubMed  Google Scholar 

  40. Meyer BJ, Russo C, Talbot A (1995) Discourse comprehension and problem solving: decisions about the treatment of breast cancer by women across the life span. Psychol Aging 10(1):84–103

    Article  CAS  PubMed  Google Scholar 

  41. Kinnersley P, Edwards A, Hood K, Cadbury N, Ryan R, Prout H, Owen D, Macbeth F, Butow P, Butler C (2007) Interventions before consultations for helping patients address their information needs. Cochrane Database Syst Rev 18(3):CD004565

    Google Scholar 

  42. Pitkethly M, Macgillivray S, Ryan R (2008) Recordings or summaries of consultations for people with cancer. Cochrane Database Syst Rev 16(3):CD001539

    Google Scholar 

  43. Legare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, Graham ID, Turcotte S (2010) Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 5:CD006732

    PubMed  Google Scholar 

  44. Andersen MR, Bowen DJ, Morea J, Stein KD, Baker F (2009) Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 28(1):29–37

    Article  PubMed  Google Scholar 

  45. Levit LA BE, Nass SJ (2013). In: Ganz PA (ed) Delivering high-quality cancer care, charting a new course for a system in crisis. Institute of Medicine of the National Academies. Washington, DC: The National Academies Press

  46. Pinquart M, Duberstein PR (2004) Information needs and decision-making processes in older cancer patients. Crit Rev Oncol Hematol 51(1):69–80

    Article  PubMed  Google Scholar 

  47. Maly RC, Leake B, Silliman RA (2003) Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer 97(6):1517–1527

    Article  PubMed  Google Scholar 

  48. Politi MC, Studts JL, Hayslip JW (2012) Shared decision making in oncology practice: what do oncologists need to know? Oncologist 17(1):91–100

    Article  PubMed Central  PubMed  Google Scholar 

  49. Col NF, Duffy C, Landau C (2005) Commentary–surgical decisions after breast cancer: can patients be too involved in decision making? Health Serv Res 40(3):769–779

    Article  PubMed Central  PubMed  Google Scholar 

  50. Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E et al (2007) Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 8(12):1101–1115

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We are grateful to Christine Gordon, MPH, Maria Cecilia Griggs, MPH, and Rossana Valencia, MPH, for their work recruiting patients to this study. We are also grateful to Elena Morozov at Beth Israel Deaconess Medical Center, and Julie Ferragamo and Jane Pietrantonio at Brigham and Women’s Hospital for helping us to identify patients for this study. Written permission has been obtained from all persons named in this acknowledgment. Dr. Schonberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Mara Schonberg was supported by a Paul B. Beeson Career Development Award in Aging supported by the National Institute on Aging K23 [K23AG028584], The John A. Hartford Foundation, The Atlantic Philanthropies, The Starr Foundation, and The American Federation for Aging Research.

Conflict of interest

Dr. Fein-Zachary received $1,500 as a consultant for Siemens Medical Solutions USA, Inc. in 2013. Otherwise, the authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws of the United States of America.

Financial disclosure information

This research was supported by a Paul B. Beeson Career Development Award in Aging supported by the National Institute on Aging K23 [K23AG028584], The John A. Hartford Foundation, The Atlantic Philanthropies, The Starr Foundation, and The American Federation for Aging Research.

Author information

Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 1309 Beacon, Office 219, Brookline, Boston, MA, 02446, USA

    Mara A. Schonberg & Lindsay Hintz

  2. Breast Imaging, Department of Radiology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA

    Robyn L. Birdwell

  3. Division of Hematology and Oncology, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Brittany L. Bychkovsky

  4. Breast Imaging, Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Valerie Fein-Zachary

  5. Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Michael D. Wertheimer

  6. Section of Geriatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    Rebecca A. Silliman

Authors
  1. Mara A. Schonberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robyn L. Birdwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brittany L. Bychkovsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lindsay Hintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valerie Fein-Zachary
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael D. Wertheimer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rebecca A. Silliman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mara A. Schonberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schonberg, M.A., Birdwell, R.L., Bychkovsky, B.L. et al. Older women’s experience with breast cancer treatment decisions. Breast Cancer Res Treat 145, 211–223 (2014). https://doi.org/10.1007/s10549-014-2921-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-014-2921-y

Keywords

Search

Navigation