Abstract

Research demonstrates that older breast cancer patients are less likely to receive surgery for operable breast cancer
compared to younger post menopausal women. The Cancer Reform Strategy states that the only acceptable criteria for
older people not having clinically appropriate treatment are patient choice and poor health. This study will investigate
the role of patient health and choice in the surgical treatment decision for older women with breast cancer from the
perspective of both the patient and their surgeon. It will also help determine which health measures best predict post
surgical complications and quality of life for older breast cancer patients.

We will follow the treatment of 550 patients aged ≥70 years with operable breast cancer and interview them regarding
their surgical choices and general health. We will also ask surgeons to tick one of five responses, of a standard
measure of decision making, immediately following the consultation in which the surgical decision was taken. As a
result, we will attain a measure of who took primary responsibility for the treatment decision as agreed by both patient
and surgeon. This will help to identify whether the difference in surgery between older and younger patients is due to
older patients choosing not to have surgery.

Knowing the extent to which older people's experience of nonstandard treatment is due to patient choice and poor
health will help to establish whether older women are unduly receiving suboptimal treatment and provide evidence to
encourage change in practice. Measures identified as accurate predictors of post surgery complications and quality of
life could be considered for future use in clinical settings to help make treatment decisions