It is unkno
wn
what
mini
mal benefit in disease-free survival older patients
with breast cancer require fro
m adjuvant syste
mic therapy, and if this differs fro
m that required by younger patients. We prospectively exa
mined patients' preferences for adjuvant che
motherapy (aCT) and adjuvant hor
monal therapy (aHT), factors related to
mini
mally-required benefit, and patients' self-reported
motivations.
Patients and Methods
Fifty-two younger (40-64 years) and 29 older (≥ 65 years) women with a first primary, invasive tumor were interviewed post-surgery, prior to receiving aCT/aHT recommendation.
Results
The proportions of younger versus older participants who would accept, refuse, or were undecided about therapy were 92% versus 62%, 4% versus 24%, and 4% versus 14% for aCT, and 92% versus 59%, 8% versus 17%, and 0% versus 24% for aHT. The proportion of older participants who would refuse rather than accept aCT was larger than that of younger participants (m>Pm> = .005). No significant difference was found for aHT (m>Pm> = .12). Younger and older participants' minimally-required benefit, in terms of additional 10-year disease-free survival, to accept aCT (median, 5% vs. 4%; m>Pm> = .13) or aHT (median, 10% vs. 8%; m>Pm> = .15) did not differ. Being single/divorced/widowed (odds ratio [OR], 0.16; m>Pm> = .005), presence of geriatric condition (inability to perform daily activities, incontinence, severe sensory impairment, depression, polypharmacy, difficulties with walking; OR, 0.27; m>Pm> = .047), and having a preference to make the treatment decision either alone or after considering the clinician's opinion (active role; OR, 0.15; m>Pm> = .012) were independently related to requiring larger benefits from aCT. The most frequent motivations for/against therapy included the wish to survive/avoid recurrence, clinician's recommendation, side effects, and treatment duration (only aHT).
Conclusion
Whereas older participants were less willing to accept aCT than younger participants, no significant difference was found for aHT. However, a majority of older participants would still accept both therapies. Adjuvant systemic therapy should be discussed with eligible patients regardless of age.