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Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT

Wyld, Lynda, Reed, Malcolm W.R., Collins, Karen, Ward, Sue, Holmes, Geoff, Morgan, Jenna, Bradburn, Mike, Walters, Stephen, Burton, Maria, Lifford, Kate, Edwards, Adrian, Brain, Kate, Ring, Alistair, Herbert, Esther, Robinson, Thompson G., Martin, Charlene, Chater, Tim, Pemberton, Kirsty, Shrestha, Anne, Nettleship, Anthony, Richards, Paul, Brennan, Alan, Cheung, Kwok Leung, Todd, Annaliza, Harder, Helena, Audisio, Riccardo, Battisti, Nicolo Matteo Luca, Wright, Juliet, Simcock, Richard, Murray, Christopher, Thompson, Alastair M., Gosney, Margot, Hatton, Matthew, Armitage, Fiona, Patnick, Julietta, Green, Tracy, Revill, Deirdre, Gath, Jacqui, Horgan, Kieran, Holcombe, Chris, Winter, Matt, Naik, Jay and Parmeshwar, Rishi 2022. Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT. Programme Grants for Applied Research 10 , 6. 10.3310/XZOE2552

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Abstract

Background In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to base treatment recommendations. Aim We aimed to optimise treatment choice and outcomes for older women (aged ≥ 70 years) with operable breast cancer. Objectives Our objectives were to (1) determine the age, comorbidity, frailty, disease stage and biology thresholds for endocrine therapy alone versus surgery plus adjuvant endocrine therapy, or adjuvant chemotherapy versus no chemotherapy, for older women with breast cancer; (2) optimise survival outcomes for older women by improving the quality of treatment decision-making; (3) develop and evaluate a decision support intervention to enhance shared decision-making; and (4) determine the degree and causes of treatment variation between UK breast units. Design A prospective cohort study was used to determine age and fitness thresholds for treatment allocation. Mixed-methods research was used to determine the information needs of older women to develop a decision support intervention. A cluster-randomised trial was used to evaluate the impact of this decision support intervention on treatment choices and outcomes. Health economic analysis was used to evaluate the cost–benefit ratio of different treatment strategies according to age and fitness criteria. A mixed-methods study was used to determine the degree and causes of variation in treatment allocation. Main outcome measures The main outcome measures were enhanced age- and fitness-specific decision support leading to improved quality-of-life outcomes in older women (aged ≥ 70 years) with early breast cancer.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence
Publisher: NIHR Journals Library
ISSN: 2050-4322
Date of First Compliant Deposit: 7 July 2022
Date of Acceptance: 5 July 2022
Last Modified: 12 Jul 2022 08:12
URI: https://orca.cardiff.ac.uk/id/eprint/151111

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