Patterns of care for women with breast cancer vary substantially with patient age. Older patients with breast cancer frequently receive less than standard management, resulting in poorer outcome. At diagnosis, the health status of older women with breast cancer affects survival and treatment decisions. Age-related comorbidity may limit diagnostic tests, narrow treatment options, and significantly increase mortality not related to breast cancer. Yet, for healthy older women with early-stage breast cancer, stage-adjusted survival is similar to that of younger women. Calendar age is not sufficient to encompass the heterogeneity in health status of the elderly. Instead, management of older women with breast cancer should be based on anticipated survival, functional status, and the goals of the patient for treatment. In this review, we evaluate pertinent data and provide guidance for the management of older women with breast cancer.
[Show abstract][Hide abstract] ABSTRACT: Quality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and Spiritual well-being; 2) Examine the effects of a psychoeducational support intervention on QoL outcomes in older women; and 3) Describe nurses' perceptions of their interactions with older breast cancer survivors. A descriptive, longitudinal design was used to answer the research questions. Data for this study were drawn from the Breast Cancer Education Intervention (BCEI), a longitudinal psychoeducational support intervention for women with early stage breast cancer. Fifty women from the BCEI who were 65 years of age and older were included in this sample, of whom 24 were assigned to the Experimental (EX) Group and 26 were assigned to the Wait Control (WC) Group. Data were collected at three time points: baseline, three months, and six months after study entry. Measurement tools included the BCEI Demographics Form, the Quality of Life-Breast Cancer Survey (QoL-BC), and field notes of the BCEI Research Nurses. The QoL-BC survey is a 50-item scale that measures QoL in women with breast cancer. Descriptive statistics, Generalized Estimating Equation (GEE) methods and t-tests were used to answer research questions #1 and #2. Content analysis was used to answer research question #3. Subjects reported good overall QoL at baseline, but QoL declined over six months. Physical and Psychological well-being declined from baseline to six months later. Social well-being initially improved from baseline to three months but declined at six months. Spiritual well-being initially declined at three months and improved at six months. There was insufficient power to detect a difference in the effects of the BCEI Intervention between the two groups. However, the decline in overall QoL was less in the EX Group. Field notes focusing on nurses' perception of their interactions with older women revealed four themes. These themes include: continuing breast-related health, personal health issues, family health issues, and potential stressors. Results from this study suggest that: 1) changes in overall QoL and within the four QoL domains occur over time; 2) decline in overall QoL was lessened by the BCEI Intervention; and 3) concerns after treatment are both breast cancer and non-breast cancer related. Study findings can direct future research in the following areas: 1) identification of specific concerns within each QoL domain that could lead to an increase or decrease in well-being in older breast cancer survivors; 2) interventions tailored to the needs of older breast cancer survivors to maintain, improve, or lessen decline in QoL after treatment; and 3) reconceptualizing QoL in older breast cancer survivors to include non-cancer related factors.
[Show abstract][Hide abstract] ABSTRACT: Attrition in follow up is a key limitation of longitudinal studies, especially in cancer patients in developing countries. We did a retrospective analysis of possible factors that resulted in attrition of patients with breast cancer during follow up.
This study is a comparison between patients who came for a follow up regularly to our clinic with those who did not but could be contacted on phone or by post. A computerized grouped database was constructed with the following parameters: age, religious community, other co-morbid conditions if present, distance from place of residence to our city, residence in city/ village, initial stage of the disease, type of treatment and disease relapse or death.
Using binary logistic regression, disease relapse was found to be the most important cause of non-compliance. The odds ratio for irregularity or loss to follow up of patients with disease relapse was 2.53 (95% CI: 1.17-5.46; p = 0.02) for patients who were alive with disease relapse and 6.1 8 (95% CI: 3.47-11.02; p < 0.001) for patients who had died due to the disease compared with those who were alive and free of disease. The age and place of residence in a village were other significant factors. The odds of attrition due to age were 1.03 (95% CI: 1.01-1.05; p = 0.04) for each year of increase in age and that of residence in a village was 1.85 (95% CI: 1.02-3.36; p = 0.04).
Age, disease relapse and residing in a village are important causes of attrition during follow up of patients with breast cancer in India.
The National medical journal of India 01/2007; 20(5):230-3. · 0.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Breast cancer is the leading cause of cancer death in women in Australia. Early detection provides the best chance of reducing mortality and morbidity from the disease. Mammographic screening is a population health strategy for the early detection of breast cancer in Australia. Recruitment strategies such as regular advertising and biannual screening invitations are exclusively targeted at women aged 50 - 69 years. Even though they can participate, women 70 years or over are not invited or actively encouraged to undertake screening. Research has found that a routine letter of invitation increases the number of women participating in breast cancer screening.
Cancer data analysis and a literature and policy review was conducted to assess age specific breast cancer mortality rates and the legitimacy of rationale used to limit invitations for breast cancer screening to women younger than 70 years.
The proportion of women over 69 years participating in the BreastScreen program is significantly less than rate of screening in the target age range (50-69 years). Evidence and data indicate that common justifications for limiting screening reminders to the target age range including life expectancy, comorbidities, effectiveness, treatment and cost are, for many women, unreasonable.
There is now sufficient data to support a change in the targeted upper age range for breast cancer screening to improve the existing suboptimal surveillance in women aged over 69 years.
Australia and New Zealand Health Policy 12/2008; 5:23. DOI:10.1186/1743-8462-5-23
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