Do older women take an active role in their breast cancer treatment?

This blog post is written by Dr. Michael Wertheimer, Chief, Breast Surgery

At Beth Israel Deaconess Medical Center, we wanted to better understand how older women approach and decide on their breast cancer treatment decisions. We worked with Brigham and Women’s Hospital and Boston Medical Center, for over four years following dozens of patients’ journeys.

So far, few studies have examined how older women choose their treatments. We suspected that women 75 and older would be less engaged in the decision-making process of their treatment and more reliant on their family than women between 65 and 74 years. Engaging older women in the decision process, especially those with short life expectancy, is important because the benefits of some treatments may not be achieved for years, while the side effects may be more immediate.

We recruited women 65 and older from breast imaging centers in the three hospitals involved in the study to better understand older women’s perspectives.

Out of the eligible women invited to participate in the study, there were ultimately 70 women who were diagnosed with ductal carcinoma in situ (DCIS) or invasive breast cancer. Of the 70 women we followed, 43 were over the age of 75.

Between August 2007 and December 2011, we interviewed English-speaking older women without dementia. Women were interviewed both at the time of biopsy (before they knew their results) and six months later.

Among the areas we explored were use of mammography, history of breast biopsy and breast cancer, and family history of breast cancer. We addressed women’s willingness to undergo treatments and asked if they would accept specific treatments including surgery, radiation therapy, chemotherapy and medication.

We explored how women obtained their information from sources beyond their physicians, surgeons and assessed what other factors determined their decision (for example, transportation to getting treatment or advice from friends). We looked at who made the final treatment decision. Was it the women themselves? Did they share the decision? Or did someone other than them make the decision (family or physician)? Lastly we asked, “If you had to go through the process again, what would you do differently?”

Some of the most notable, although not surprising, findings included:

• Women 75 and older were less likely to ask their surgeons about breast cancer treatment options, were less likely to obtain information about their treatment choices from sources beyond their physicians, and were less likely to receive standard medical therapy than women 65-74 years.
• Overall, 75 percent of older women reported that their final treatment decision was made in conjunction with their physicians, with or without the help of family.
• They felt their treatment decision was really whether or not to follow their physicians’ recommendations. Not choosing between two or more options.
• Overall, many women in our study did not perceive having a choice about treatment or decided to simply follow their physicians’ recommendations.
• Even before being diagnosed with breast cancer, women 75 years and older were less likely than women 65–74 years to report that they would accept recommended treatments for breast cancer.
• Although study participants noted the importance of asking their physicians the right questions to ensure high-quality care, women 75 and older were less likely than women 65-74 years to report asking their surgeons about their treatment options.

What does this all mean? 

Older women are less engaged in breast cancer treatment decision-making than younger women and tend to accept whatever treatments are recommended by their physicians. More needs to be done to help older women engage in treatment decisions in order to ultimately improve the quality of their care.

At this point, more research needs to be done. We need to better understand the types of information that older women need to ensure high-quality decision-making without information overload (several women in our study reported that they could not absorb all the information provided to them). We also need to better understand the side effects of specific treatments on older women in order to make recommendations.

To improve the decision-making process, physicians need to provide a balanced presentation of breast cancer treatment choices.

At Beth Israel Deaconess Medical Center, we are always working to better understand breast-cancer treatments for older women and working to improve the process so that these women can take an active, and educated, role in their treatments.