Information needs of older women with early stage breast cancer when making radiotherapy decisions

Publication date: Available online 9 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Shi-Yi Wang, Gabrielle Kelly, Cary Gross, Brigid K. Killelea, Sarah Mougalian, Carolyn Presley, Liana Fraenkel, Suzanne B. Evans
PurposeEvidence suggests that radiotherapy may not have substantial benefits for older women with early-stage breast cancer, yet more than 75% of patients opt for this treatment. Given that this is a preference-sensitive decision, the utilization pattern suggests the decision-making might not be shared appropriately. The objectives of this study were to identify the information older women with early-stage breast cancer need when making radiotherapy decisions, and whom patients identify as the main decision-maker.MethodWe surveyed (through face-to-face, phone, or mail) women aged 65 and older who received lumpectomy and were considering or receiving adjuvant radiotherapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiotherapy in relation to radiotherapy decision-making. Participants also designated who was considered the key decision-maker.ResultsThe response rate was 56.4% (93/165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision-maker on receiving radiotherapy. There was wide variation in information needs regarding radiotherapy decision-making. Participants rated a mean of 18 (range: 3–24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 rated 13.9 questions as essential; whereas participants who were 74 or younger rated 18.7 as essential (p-value=.018).ConclusionsOlder women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants.

Teaser

To understand information needs for radiotherapy decision-making, we surveyed 93 older women (≥65y/o) with early-stage breast cancer. Approximately 97% of participants indicated they were the main decision-maker on receiving radiotherapy. Wide variation in information needs exists: Participants rated a mean of 18 (range: 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Younger participants (65-74 y/o) rated 18.7 as essential; whereas older participants rated 13.9 questions as essential (p-value=.018).


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