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Eur J Surg Oncol. 2015 Sep;41(9):1234-42. doi: 10.1016/j.ejso.2015.05.022. Epub 2015 Jun 12.

Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer.

Author information

1
Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: j.morgan@sheffield.ac.uk.
2
Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BA, UK. Electronic address: k.collins@shu.ac.uk.
3
Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, LE2 7LX, UK. Electronic address: tgr2@le.ac.uk.
4
School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK. Electronic address: kl.cheung@nottingham.ac.uk.
5
Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, WA9 3DA, UK. Electronic address: raudisio@doctors.org.uk.
6
Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: m.w.reed@sheffield.ac.uk.
7
Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: l.wyld@sheffield.ac.uk.

Abstract

INTRODUCTION:

Primary endocrine therapy (PET) is an alternative treatment to surgery for oestrogen receptor (ER) positive operable breast cancer in older women. However, there is variable use of PET in the UK, with up to 40% of patients aged over 70 receiving PET instead of surgery in some regions. Treatment options offered to patients rely heavily on healthcare professional (HCP) assessment and opinion on which treatments are appropriate.

MATERIALS AND METHODS:

This was a mixed methods study combining semi-structured interviews with HCPs working in high and low PET regions in the UK, followed by a postal questionnaire survey distributed via the Association of Breast Surgery (ABS).

RESULTS:

Thirty-four HCPs (20 breast surgeons; 13 nurse specialists; 1 geriatrician) were interviewed from 14 sites across the UK and 252/641 questionnaires returned (39%). There was an overriding view that PET is not suitable for patients under the age of 80 unless there are significant comorbidities. Opinion was split regarding the best way to treat patients with dementia. Patient preference was generally stated to be the most important factor when considering treatment, however only around a quarter 65/244 (26.6%) felt that all patients over the age of 70 should be offered PET as an alternative treatment option.

CONCLUSIONS:

Opinions differ on the best way to treat women over 70 with operable breast cancer, especially if they have co-existing dementia, as well as whether they should be offered PET as a treatment option. This may be a significant cause of treatment variation in the UK.

KEYWORDS:

Breast cancer; Elderly; Mixed methods; Older; Primary endocrine therapy; Surgery

PMID:
26108734
DOI:
10.1016/j.ejso.2015.05.022
[Indexed for MEDLINE]

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