This grant is a revision of grant #R01HS08516-01. Older patients (greater than 65 years) receive less aggressive care for cancer, including breast cancer, than younger patients. Despite the potential benefits of postsurgical (adjuvant) chemotherapy in older breast cancer patients, data suggests that older patients are treated much less frequently than younger postmenopausal or premenopausal patients with adjuvant chemotherapy. We believe that this is linked to physicians' beliefs that older patients are more likely to die from other diseases before they die of breast cancer, and that older women, even ones with otherwise good performance status, will generally tolerate chemotherapy poorly or would not consider the benefits worth the risks. The proposed four year study will conduct a randomized trial of an innovative decision aid, the Decision Board (DB), in postmenopausal breast cancer patients. The DB was designed to enhance patient and oncologist decision making about adjuvant therapy. The specific overall goal of this study is to improve the treatment decision making process in older women with breast cancer. The primary objectives of this study are to determine the effectiveness of the DB and to determine if it allows greater and more informed choices about adjuvant therapy for breast cancer. We will also determine how the DB affects communications between oncologists and breast cancer patients. Primary outcomes will include physician's treatment recommendation, patients' choice of treatment, satisfaction with the consultation process and the decision itself. To accomplish this we will determine the treatment preferences of 600 older breast cancer patients and characterize athe base-line treatment patterns of the 13 oncology practices participating in this study. Since the DB is being evaluated to determine its effectiveness in routine clinical practice, we will also analyze the costs and value of the introduction of this tool into the decision making process. During this four year period we will do the following: 1) complete adaptation of the DB for use with older adjuvant breast cancer patients; 2) retrospectively review the records of all participating practices during the previous 12 months to document each practices' treatment patterns; 3) conduct a randomized trial of the DB with 300 older breast cancer patients (greater than 65 years) and 300 younger (50-64 years) postmenopausal breast cancer patients; 4) evaluate how the Board affects the doctor-patient communication process; 5) examine the cost- utility of the Board; and 6) conduct a prospective review of study- eligible patients who were not accrued into the randomized trial to assess any changes in treatment patterns that may occur during the study period.
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