Older Age, Quality of Life Associated With Deviations From Initial Treatment Decisions in Breast Cancer

Nonadherence to recommended adjuvant chemotherapy in patients with breast cancer is associated with poor quality of life.
Nonadherence to recommended adjuvant chemotherapy in patients with breast cancer is associated with poor quality of life.

Nonadherence to recommended adjuvant chemotherapy in patients with breast cancer is associated with poor quality of life (QoL) in patients older than 75 years and fear of chemotherapy, according to a study published online ahead of print in the journal Supportive Care in Cancer.1

The researchers conducted this prospective multicenter cohort study to determine which patient- and physician-related factors influence nonadherence to guidelines in regard to adjuvant chemotherapy.

The study included a total of 857 patients, who completed questionnaires prior to surgery and prior to adjuvant therapy. The questionnaire assessed health-related QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, psychiatric comorbidity with the Patient Health Questionnaire (PHQ), demographic characteristics (age, education), and the intensity of fear of chemotherapy.

The tumor board discussed recommendations for adjuvant chemotherapy after surgery. The decision was documented with the indication for chemotherapy based on the German S3 guideline; tumor board was blinded to the algorithm-based decision. Whether the patient did receive adjuvant chemotherapy was documented was documented at a 6-month follow-up.

Chemotherapy was recommended for 391 of the study participants. Somatic comorbidity not allowing adjuvant chemotherapy and age older than 75 years were the most important reasons that chemotherapy was not recommended.

Among the 391 patients for whom chemotherapy was recommended, 19% (73 patients) did not receive chemotherapy. Among patients older than 75 years, poor QoL more frequently resulted in deviation from the initial therapy decision; age was not associated with deviation in older patients with good QoL. In addition, those patients who were very afraid of chemotherapy were more likely to deviate from the initial therapy decision.

REFERENCE

1. Schwentner L, Van Ewijk R, Flock F, et al. Exploring patient- and physician-related factors preventing breast cancer patients from guideline-adherent adjuvant chemotherapy—results from the prospective multi-center study BRENDA II [published online ahead of print January 27, 2016]. Support Care Cancer. doi:10.1007/s00520-016-3088-3.

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