Satisfaction and Regret With Decision Making in Older Women With Breast Cancer.

Abstract

PURPOSE/OBJECTIVE(S)\nShared decision making is a fundamental component of the conversation between physicians and older women with early-stage breast cancer making decisions to omit radiation therapy. The purpose of this study is to report patient comfort and satisfaction levels with decision making.\n\n\nMATERIALS/METHODS\nWomen with pre-invasive or early-stage breast cancer who had been given the option to omit radiation therapy were identified. Two validated instruments (decisional regret and satisfaction with decision) were provided to all women with 5 choices (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree). All women then underwent a qualitative interview about their decision making process, and were given option of $50.00 gift card after completion. Interviews were transcribed, and common themes were coded using qualitative data analysis software by two members of the research team.\n\n\nRESULTS\nThirty-six women diagnosed with early stage or pre-invasive breast cancer from 2013-2020 were consented. Median age at diagnosis was 72. Twenty (55%) chose to omit RT. Majority of women (92%) agreed or strongly agreed that it was the right decision, and that they were satisfied about being adequately informed about the issues that were important to the decision making process. In women who had chosen radiation therapy, one woman expressed regret regarding side effects of radiation therapy: So with the surgery and the shrinking, then I think I would have been better off if I had gone with a mastectomy and probably a double and then had reconstruction. Other women expressed regret with radiation in the context of coordinating the complexities of treatment: I might have decided to just have a double mastectomy. I wouldn t had to have the cancer drug. I wouldn t have had the radiation. It was just much more complicated than I thought in my mind, and then again, in my head, there s something about putting radiation into my body when there s another option where one is putting something in and the pill is taking something out. While no women expressed regret regarding omission of radiation (pre- and post-COVID-19 pandemic), some women expressed knowledge deficit or poor expectation of the side effects of hormonal blockade: We really didn t talk about the side effects. I ve gotten more information from my friends that are on the pill than I have from the doctor. Doctor s attitude was you need to take this, and you re going to take it, and we re going to monitor you, [the medical oncologist] said I shouldn t have any problem. \n\n\nCONCLUSION\nOlder women with early-stage breast cancer offered options for omission of radiation therapy did not express regret regarding their decision to omit radiation, but sometimes felt that they were not informed about the expectations and side effects of hormonal blockade. Additional educational tools to assist in adjuvant therapy decision making regarding radiation therapy and endocrine therapy options are warranted.