): The elderly, who represent half of the 185,000 new cases of breast cancer and two-thirds of the deaths, have failed to realize any of the benefits of recent mortality reductions seen in younger women. At present, more than 40 percent of the elderly women who are diagnosed each year will have regional disease, where adjuvant chemotherapy can have survival benefits. The St. Gallens conference and the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer include recommendations for chemotherapy for elderly women. However, actual patterns of care diverge substantially from these recommendations, with only 30 percent of elderly women receiving some chemotherapy. Under use of chemotherapy is one of the key problems in the quality of cancer care recently identified by the Institute of Medicine. Patient preferences are becoming increasingly important in clinical decisions, such as chemotherapy, where benefits may be low and toxicity high. At present, we do not understand how preferences contribute to the divergence of the patterns of care and guidelines for the elderly, and we have little data concerning the outcomes of chemotherapy in this age group. To fill this gap, Lombardi Cancer Center?s Cancer and Aging and Outcomes Research programs, together with the Cancer and Leukemia Group B (CALGB) propose to study a large prospective cohort of newly-diagnosed elderly breast cancer patients with regional disease. The primary goal of this project is to use a theory-driven conceptual model of patient preferences to identify modifiable factors associated with chemotherapy decisions and subsequent quality of life and satisfaction. We are also interested in the role of co-morbidity in preferences, decisions, and outcomes. Model components have been selected to yield data that can be directly applicable to interventions and policy recommendations. Data will be collected from 1,300 women 4-6 six weeks after diagnosis in standardized telephone interviews; women will be re-interviewed 6 months, 1, 2, and up to 3 years following study entry. Records will be reviewed at baseline and annually thereafter for clinical data.
The specific aims are: 1) to describe the relationship between preferences and chemotherapy decisions, and to understand how factors which can be targets for interventions mediate this relationship; 2) to examine the relationships between preference-based chemotherapy decisions and 6-month and 1 (and 2 and 3) year quality of life, and satisfaction with treatment decisions; and 3) to describe disease-free survival. All of the potential interventions which will follow from these data can be designed for use in cooperative group settings. Interventions derived from this project, hold the promise of improving the quality of care for the fastest growing segment of the breast cancer population.
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