Katrina Lavelle

Non-standard management of breast cancer increases with age in the UK: a population based cohort of women ⩾65 years

Evidence suggests that compared to younger women, older women are less likely to receive standard management for breast cancer. Whether this disparity persists once differences in tumour characteristics have been adjusted for has not been investigated in the UK. A retrospective cohort study involving case note review was undertaken, based on the North Western Cancer Registry database of women aged ⩾65 years, resident in Greater Manchester with invasive breast cancer registered over a 1-year period (n=480). Adjusting for tumour characteristics associated with age by logistic regression analyses, older women were less likely to receive standard management than younger women for all indicators investigated. Compared to women aged 65–69 years, women aged ⩾80 years with operable (stage 1–3a) breast cancer have increased odds of not receiving triple assessment (OR=5.5, 95% confidence interval (CI): 2.1–14.5), not receiving primary surgery (OR=43.0, 95% CI: 9.7–191.3), not undergoing axillary node surgery (OR=27.6, 95% CI: 5.6–135.9) and not undergoing tests for steroid receptors (OR=3.0, 95% CI: 1.7–5.5). Women aged 75–79 years have increased odds of not receiving radiotherapy following breast-conserving surgery compared to women aged 65–69 years (OR=11.0, 95% CI: 2.0–61.6). These results demonstrate that older women in the UK are less likely to receive standard management for breast cancer, compared to younger women and this disparity cannot be explained by differences in tumour characteristics.

Older women with operable breast cancer are less likely to have surgery.

Older women are less likely to receive standard management for breast cancer than younger postmenopausal women. Whether differences in general health explain variations in the rates of surgery is not known.

Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study

Background:Older women have lower breast cancer surgery rates than younger women. UK policy states that differences in cancer treatment by age can only be justified by patient choice or poor health.Methods:We investigate whether lack of surgery for older patients is explained by patient choice/poor health in a prospective cohort study of 800 women aged ⩾70 years diagnosed with operable (stage 1–3a) breast cancer at 22 English breast cancer units in 2010–2013. Data collection: interviews and case note review. Outcome measure: surgery for operable (stage 1–3a) breast cancer <90 days of diagnosis. Logistic regression adjusts for age, health measures, tumour characteristics, socio-demographics and patient’s/surgeon’s perceived responsibility for treatment decisions.Results:In the univariable analyses, increasing age predicts not undergoing surgery from the age of 75 years, compared with 70–74-year-olds. Adjusting for health measures and choice, only women aged ⩾85 years have reduced odds of surgery (OR 0.18, 95% CI: 0.07–0.44). Each point increase in Activities of Daily Living score (worsening functional status) reduced the odds of surgery by over a fifth (OR 0.23, 95% CI: 0.15–0.35). Patient’s role in the treatment decisions made no difference to whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive, that is, left the decision up to the surgeon.Conclusion:Lower surgery rates, among older women with breast cancer, are unlikely to be due to patients actively opting out of having this treatment. However, poorer health explains the difference in surgery between 75–84-year-olds and younger women. Lack of surgery for women aged ⩾85 years persists even when health and patient choice are adjusted for.

Do postage stamps versus pre-paid envelopes increase responses to patient mail surveys? A randomised controlled trial

BackgroundStudies largely from the market research field suggest that the inclusion of a stamped addressed envelope, rather than a pre-paid business reply, increases the response rate to mail surveys. The evidence that this is also the case regarding patient mail surveys is limited.MethodsThe aim of this study is to investigate whether stamped addressed envelopes increase response rates to patient mail surveys compared to pre-paid business reply envelopes and compare the relative costs. A sample of 477 initial non-responders to a mail survey of patients attending breast clinics in Greater Manchester between 1/10/2002 – 31/7/2003 were entered into the trial: 239 were randomly allocated to receive a stamped envelope and 238 to receive a pre-paid envelope in with their reminder surveys. Overall cost and per item returned were calculated.ResultsThe response to the stamped envelope group was 31.8% (95% CI: 25.9% – 37.7%) compared to 26.9% (21.3% – 32.5%) for the pre-paid group. The difference (4.9% 95% CI: -3.3% – 13.1%) is not significant at α = 0.05 (χ2 = 1.39; 2 tailed test, d.f. = 1; P = 0.239). The stamped envelopes were cheaper in terms of cost per returned item (£1.20) than the pre-paid envelopes (£1.67). However if the set up cost for the licence to use the pre-paid service is excluded, the cost of the stamped envelopes is more expensive than pre-paid returns (£1.20 versus £0.73).ConclusionCompared with pre-paid business replies, stamped envelopes did not produce a statistically significant increase in response rate to this patient survey. However, the response gain of the stamped strategy (4.9%) is similar to that demonstrated in a Cochrane review (5.3%) of strategies to increase response to general mail surveys. Further studies and meta analyses of patient responses to mail surveys via stamped versus pre-paid envelopes are needed with sufficient power to detect response gains of this magnitude in a patient population.

Pretreatment health measures and complications after surgical management of elderly women with breast cancer

Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co‐morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group.

Why are older women not having surgery for breast cancer? A qualitative study

Surgery is the mainstay of treatment for breast cancer. However, there is evidence that older women are not receiving this treatment. This study explores reasons why older women are not having surgery.

Why are older women not having surgery for breast cancer

Surgery is the mainstay of treatment for breast cancer. However, there is evidence that older women are not receiving this treatment. This study explores reasons why older women are not having surgery.