A study looking at the decision making of elderly women with breast cancer (AChEW)

The research team found that there were a number of reasons that older women did or did not have chemotherapy. And that the number of women who had chemotherapy varied widely between hospitals.

This study recruited women aged 70 and over who had recently been diagnosed with early stage breast cancer.

In the first part of the study, doctors of 803 women completed questionnaires about their decision to offer chemotherapy or not.

The research team found that only 116 of the 803 women (14%) were offered chemotherapy. Of these 116 women, 66 decided to have the treatment.

When they looked in more detail they found that 309 women had cancer that was more likely to come back after surgery (high risk cancer). Of these 309 women, 94 women (30%) were offered chemotherapy and 53 decided to have the treatment.

Doctors were more likely to offer chemotherapy to those women who

• Were younger or fitter
• Had cancer that was likely to grow more quickly (high grade )
• Had a type of cancer that meant other treatments (such as hormone therapy) may not work

Doctors were less likely to offer chemotherapy to those women who

• Were older or more frail
• Had other treatment options available that may work well
• They thought were less likely benefit from treatment

But there was no set method of deciding who had treatment, and decisions varied from hospital to hospital.  The research team concluded that there should be guidelines to standardise care for older women with breast cancer.

In the second part of the study, the research team did in depth interviews with 58 women.

They found that most women were satisfied with the information they had about chemotherapy, and how the doctor or nurse explained the treatment. About 3 out of 5 women said that they wanted to make the decision to have chemotherapy or not together with their doctor. About 1 in 5 women wanted to make the decision themselves, and 1 in 5 wanted the doctor to decide.

Women who decided to have chemotherapy did so to help stop the cancer coming back, and because the doctor recommended it.

Those who decided not to have chemotherapy did so because of possible side effects and impact on their quality of life, and because the doctor recommended not to.

The trial team concluded that doctor recommendation was important for older women who are deciding whether to have breast cancer treatment. And that there needs to be good communication between the doctor, the patient and their family.

We have based this summary on information from the team who ran the trial. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team. We have not analysed the data ourselves.