Preferences for quality of life versus length of life in older women deciding about treatment for early breast cancer: A cross-sectional sub-analysis of the Bridging the Age Gap study

Abstract

Introduction

Prioritising quality of life (QoL) or length of life is often necessary in the decision-making process for cancer care. This may be complicated in patients with limited life expectancy due to age and comorbidities. Older women with early breast cancer often receive non-standard care (primary endocrine therapy [PET] or omission of chemotherapy or radiotherapy) to reduce treatment morbidity and maintain QoL. We aimed to determine the perceived relative influence of QoL versus length of life in treatment decision making by older women with early (potentially curable) breast cancer.

Materials and Methods

This was a sub-study of the Age Gap multi-centre, cohort study, which prospectively recruited women >70 yrs. with early breast cancer. Baseline demographics, health characteristics, and QoL scores were analysed alongside a bespoke questionnaire to assess QoL and length of life preferences, including a modified version of the validated quality/quantity questionnaire, in a subset of the main study.

Results

The questionnaire was sent to 308 patients and 194 (63 %) were returned by participants with a median age of 75 years (range 70–93). Of these, 14 had PET and 180 had standard treatment (ST) (surgery +/− adjuvant therapy) including 37 who had chemotherapy. The PET group was older (median age 83.5 versus 76 years) and in poorer health (9/14; 64.3 % patients had one or more comorbidities versus 69/144; 47.9 %) with inferior baseline physical domain QoL scores. Patients who received PET valued QoL and length of life equally (Q score 0.87, L score 0.91), and patients who received chemotherapy favoured length of life over QoL (Q score 0.67, L score 0.86). Subgroup analysis showed a small correlation between increasing age and QoL preferences (Spearman's r = 0.2, P < 0.009). There was no correlation between co-morbidities, frailty, or global QoL and length of life/QoL preferences.

Discussion

Older women with early breast cancer valued length of life and QoL highly, with an association between preference for QoL and less aggressive treatment choices. Relative QoL preference increased with advancing age. More research is needed to define QoL determinants and outcomes following treatment to help patients make decisions that reflect their priorities.

Trial Registration Number

ISRCTN: 46099296.