Factors influencing older women's decision‐making related to treatment of operable breast cancer: A qualitative systematic review

Objective: There is variation in practice in the treatment of older women with breast cancer. International guidelines highlight the importance of patient autonomy in treatment decision‐making. The aim of this study is to identify factors which influence decision‐making in older women with operable breast cancer, which will enable us to further understand how to support these patients. Methods: Systematic review in accordance with the PRISMA guidelines was performed to identify factors which influence treatment decision‐making in older women with operable breast cancer. Medline, Web of Science and SCOPUS were searched. Results: The search yielded 5840 results; 13 articles met the inclusion criteria and reported on a total of 1118 women. Thematic analysis identified three key themes in which decision‐making factors could be categorised. These were healthcare‐related factors, patient‐related factors and impact of treatment. Healthcare‐related factors included communication with clinicians and provision of information. Patient‐related factors were age, pre‐existing knowledge, preconceptions of breast cancer and treatment, decision‐making style and co‐morbidities. The impact of treatment considerations included body image and effect on quality of life. Decision‐making style was frequently reported; older women did not demonstrate one preferred style. Conclusions: The findings have highlighted the complex interplay of factors which influence how older women make breast cancer treatment‐decisions. Clinicians should have an awareness of the factors highlighted to maximise their ability to provide support and personalised care to older women with breast cancer whilst treatment decisions are made

Long term health related quality of life following colorectal cancer surgery: patient reported outcomes in a remote follow-up population

Background: Remote follow-up (RFU) after colorectal cancer (CRC) surgery allows delivery of surveillance tests without the need for regular outpatient clinical appointments. However, little is known about health related quality of life (HRQoL) in RFU patients.Methods: EQ-5D, QLQ-C30 and QLQ-C29 questionnaires were distributed to CRC patients enrolled in a RFU programme. The primary outcome of HRQoL scores was analysed by year of RFU, demographics, operation-type, stoma and adherence to RFU protocols. Results:428 respondents (59.3%), mean age of 71years(SD 10.1) and a median RFU time of 2.6years (IQR: 1.6-4.8 years) were included. 26.6% of patients reported ‘perfect health’. The median EQ-5D index score was 0.785 (IQR: 0.671-1) and QLQ-C30 Global HRQoL score was 75 (IQR: 58.3-83.3). Females had significantly lower EQ-5D median score of 0.767 (IQR: 0.666-0.879, p=0.0088). Lower QLQ-C30 HRQoL scores were seen in stoma patients, median 66.6 (IQR: 58.3-83.3, p=0.0029). Erectile dysfunction (p=0.0006) and poor body image (p=0.001) were also reported more frequently in stoma patients. Patients undergoing right-sided resection reported a lower median EQ-5D score of 0.765 (IQR: 0.666-0.879, p=0.028) and higher pain severity (p=0.0367) compared with left-sided resections. There were 128 (29.4%) patients that breached RFU protocol and were seen in adhoc colorectal clinics. However, there was no statistical difference in HRQoL between patients who adhered to or breached RFU protocols.Conclusions: Overall HRQoL in patients in RFU is good, with no difference in those strictly followed up remotely. However, females, right-sided resections and patients with stomas may require additional clinical reviews.