Breast Cancer Care: Valuing Older Women - recommendations for improving the treatment and care of older women with breast cancer
By Lizzie Magnusson, Policy Analyst, Breast Cancer Care
Breast Cancer Care is publishing recommendations on how to improve outcomes and experiences for older women with breast cancer in a new policy briefing, supported by Age UK. Breast cancer risk increases with age and around a third of female breast cancers are diagnosed in patients aged 70 and over. However, we know that these older patients have poorer relative survival rates. This may be explained by delays in diagnosis and the ‘under-treatment’ of older breast cancer patients.
Some older women delay presenting to their doctors with suspicious symptoms meaning that their breast cancers may be more likely to be diagnosed at a more advanced stage with the possibility of reduced treatment options and inferior outcomes. It is important that breast cancer awareness information reaches those most at risk of developing breast cancer - such as older women. Breast health promotion campaigns should include images of older women to make clear the relevance of this information to women in this age group. The media also have a role to play; running breast cancer stories accompanied by pictures of younger women gives the false impression that breast cancer is not a relevant health concern for those in later life.
There is strong evidence that older women tend not to have their breast cancer managed in accordance with evidence-based national clinical guidelines, often with the omission of surgery, even when there is no clinical reason for this conservatism. There is a growing body of evidence around the usefulness of integrating the principles and practices of elderly care into oncology.
Breast Cancer Care recommends that breast multi-disciplinary teams (MDTs) consider using comprehensive geriatric assessment (CGA) tools in the treatment decision-making process for older women. CGA tools offer a useful way of making treatment decisions on the basis of functional status rather than chronological age. We are also concerned that many older women may not be having their information and support needs adequately assessed and addressed as part of their breast cancer treatment and care. CGA tools may also be useful in assessing the psycho-social needs of older women, for example mental health issues, or help needed with daily living activities.
It is also important that the treatment decision-making process adequately takes into account the informed preferences of the patient and the impact of other significant factors in that person’s life. Breast cancer is unlikely to be an older patient’s only health concern. An older patient is also more likely to have a burden of caring responsibilities.
Grace, 68, was diagnosed with breast cancer six years ago and says she felt, “like a non-person, like a piece of meat on a conveyor belt with no voice and no right to information”.
“Initially, there was no discussion. I was informed that ‘what we did’ was the gold standard. I had to push for other options and was discouraged from exploring the treatment I wanted. My other medical conditions were glossed over (ischaemic heart disease, asthma, high blood pressure, osteoporosis). Also my emotional fragility having just learned that my husband had throat cancer which was immediately life threatening – there was no understanding that I didn’t want us to be in different hospitals at the same time. I was told there were young women [with breast cancer] with young children and they were coping so I should.”
At the crux of this briefing is how important it is that older women are valued in the health system and given personalised care appropriate to their individual situations. Breast Cancer Care is calling for older women to be specifically and effectively targeted by health promotion campaigns as the people most at risk of developing breast cancer and for older patients to receive personalised care plans for their breast cancer treatment, based on that patient’s individual circumstances rather than their chronological age.
To learn more about the launch of Improving outcomes and experiences for older women with breast cancer and to obtain a copy of the briefing (to be published after 17th November 2011), go to www.breastcancercare.org.uk/olderwomen