The decision-making process for senior cancer patients: treatment allocation of older women with operable breast cancer in the UK

作     者：Jenna L.Morgan Paul Richards Osama Zaman Sue Ward Karen Collins Thompson Robinson Kwok-Leung Cheung Riccardo A.Audisio Malcolm W.Reed Lynda Wyld on behalf of the Bridging the Age Gap in Breast Cancer Trial Management Team 

作者机构：Academic Unit of Surgical Oncology University of Sheffield Medical School Health Economics and Decision Science School for Health and Related Research University of Sheffield Center for Health and Social Care Research Sheffield Hallam University Collegiate Crescent Department of Cardiovascular Sciences University of Leicester School of Medicine University of Nottingham Royal Derby Hospital Center Department of Surgery University of Liverpool St Helens Teaching Hospital Brighton and Sussex Medical School University of Sussex 

出 版 物：《Cancer Biology & Medicine》 (癌症生物学与医学（英文版）)

年 卷 期：2015年第12卷第4期

页      面：308-315页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant No. RP-PG-1209-10071) 

主　　题：Frail elderly breast neoplasms decision making 

摘      要：Objective: Up to 40% of women over 70 years with primary operable breast cancer in the UK are treated with primary endocrine therapy(PET) as an alternative to surgery. A variety of factors are important in determining treatment for older breast cancer patients. This study aimed to identify the patient and tumor factors associated with treatment allocation in this ***: Prospectively collected data on treatment received(surgery vs. PET) were analysed with multivariable logistic regression using the variables age, modified Charlson Comorbidity Index(CCI), activities of daily living(ADL) score, Mini-Mental State Examination(MMSE) score, HER2 status, tumour size, grade and nodal status. Results: Data were available for 1,122 cancers in 1,098 patients recruited between February 2013 and June 2015 from 51 UK hospitals. About 78% of the population were treated surgically, with the remainder being treated with PET. Increasing patient age at diagnosis, increasing CCI score, large tumor size(5 cm or more) and dependence in one or more ADL categories were all strongly associated with non-surgical treatment(P0.05).Conclusion: Increasing comorbidity, large tumor size and reduced functional ability are associated with reduced likelihood of surgical treatment of breast cancer in older patients. However, age itself remains a significant factor for non-surgical treatment; reinforcing the need for evidence-based guidelines.