Abstract P6-11-16: Survey on attitude towards treatment recommendations for elderly patients with breast cancer
Authors: Nakayama Kanako , Shimizu Chikako , Iino Keiko , Watanuki Shigeaki , Sawaki Masataka 
Published: March 2020

Background: With the rapid aging of the society, breast cancer in elderly people is also increasing. Although it is important to avoid unnecessary toxicity to maintain the quality of life of elderly patients, it is suggested that they are undertreated compared to younger counterparts which leads to poorer outcomes. The objective of this study was to assess the practice of the clinical care for elderly breast cancer patients aged 75 or over, and to explore the factors associated with physicians’ attitude regarding treatment recommendations towards elderly breast cancer patients in Japan. Methods: We conducted an online survey towards 1690 Breast Care Specialists belonging to the Japanese Breast Cancer Society. The respondents were asked to complete a questionnaire including (1) sociodemographic background, (2) hypothetical case scenarios in patients with Stage IIB breast cancer, (3) clinical experience of elderly breast cancer patients, (4) Good Death Inventory (GDI), a measure for evaluating good death from the bereaved family member's perspective and (5) belief regarding cancer treatment for elderly breast cancer patients. We used descriptive statistics to summarize respondents' sociodemographic data. Chi-square tests were used to evaluate differences in proportion. Differences in GDI scores were estimated using Mann-Whitney tests. Statistical analyses were performed using SPSS software. Results: 508 (30%) physicians responded to the survey. 353 (69.4%) were male. 464 (91.3%) were breast surgeons and 43 (8.4%) were others, including medical oncology, radiology and general surgery. 46 (9%), 115 (22.6%), 284 (55.9%) and 47 (9.3%) belonged to cancer centers, university hospitals, general hospitals and clinics, respectively. 136 (26.8%) of the physicians responded that they have a specialized department or a team which serve for elderly patients in their institutions, whereas 369 (72.6%) answered there was no such support. In questions based on hypothetical case scenarios, significantly more physicians responded that they would not recommend chemotherapy in a 78 year-old with luminal-type breast cancer, good performance status (PS) and no complications compared to a 55 year-old with the same clinical status (p&lt;0.001). Physicians who would recommend chemotherapy significantly decreased in a clinical scenario of a 78 year-old with the same clinical stage and subtype but with a lower PS and some complications (p&lt;0.001). More physicians recommended chemotherapy in a 78 year-old with HER2 type tumor compared to a patient with luminal type tumor when the PS and complication status were the same (p&lt;0.001). The respondents’ GDI Scores were not related to the treatment recommendations in any clinical scenario. Physicians who treated larger number of outpatients per day and those who had lower proportion of elderly patients in the clinic tended not to recommend chemotherapy for elderly patients with poorer PS and serious complications. Those who believed that “it is a doctor’s responsibility not to pursue aggressive chemotherapy in elderly patients” tended not to recommend chemotherapy in a 78-year-old patient with luminal type breast cancer with good PS and without complication.

Conclusions: The attitude towards treatment recommendation on adjuvant chemotherapy in elderly breast cancer patients were related to performance status, complications and subtype of the tumor. Physicians’ experience and belief may also affect their attitude.

Citation Format: Kanako Nakayama, Chikako Shimizu, Keiko Iino, Shigeaki Watanuki, Masataka Sawaki. Survey on attitude towards treatment recommendations for elderly patients with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-16.