Age Gap Workstream 2 ‘Treatment Decision Support’ includes developing and evaluating whether use of decision support interventions (DESIs) helps to improve the QoL, decision quality/regret, satisfaction and treatment understanding of older women with breast cancer.
The DESIs are aimed at women facing a choice of surgery or primary endocrine therapy (PET), or following surgery for those women with higher risk breast cancer, a choice of chemotherapy or no chemotherapy.
The DESIs comprise two patient facing booklets designed especially for older women facing the choice PET or surgery, and chemotherapy or no chemotherapy, two option grids (a single sheet of A4 with a table format giving ‘at a glance’ information about the pros and cons of each choice based on frequently asked questions) dealing with these two choices, and two web-based algorithms which can be used by the clinical team for the calculation of the individual risks and benefits of different treatment strategies for an older woman (taking into account her age, frailty, co-morbidities, cancer type and stage) which may be shared with an individual patient.
The PET versus surgery DESIs are currently implemented in half of the Age Gap recruiting sites (selected via cluster randomisation) as part of standard care. These sites have been trained in their use which will become a routine part of the counselling they are able to offer all women, whether they are participants in the Age Gap cohort study or not.
SHORE-C is involved in the development and evaluation of the chemotherapy or no chemotherapy DESIs (patient booklet and option grid) which are partly based on the results of the AChEW (Adjuvant chemotherapy for elderly women with early stage breast cancer) study. These DESIs are currently undergoing further field testing and will be tested at a later stage for their usability, acceptability and utility.
Links to additional websites for more information about this study are below: http://www.sheffield.ac.uk/oncology-metabolism/research/surgicaloncology/research/agegap
Harder H, Ballinger R, Langridge C, Ring A, Fallowfield LJ Adjuvant chemotherapy in elderly women with breast cancer: patients' perspectives on information giving and decision making. Psycho-Oncology (22)12: 2729-2735, 2013
Ring A, Harder H, Langridge C, Ballinger RS, Fallowfield LJ Adjuvant chemotherapy in elderly women with breast cancer (AChEW): an observational study identifying MDT perceptions and barriers to decision making. Annals of Oncology 24(5): 1211-9, 2013.doi:10.1093/annonc/mds642
R Leonard, R Ballinger, D Cameron, P Ellis, L Fallowfield, M Gosney, L Johnson, L S Kilburn, A Makris, J Mansi, M Reed, A Ring, A Robinson, P Simmonds, G Thomasand J M Bliss.Adjuvant chemotherapy in older women (ACTION) study - what did we learn from the pilot phase? British Journal of Cancer (2011) 105, 1260-1266. doi:10.1038/bjc.2011.377
Ballinger R, Ford E, Pennery E, Jenkins V, Ring A, Fallowfield LJ. Specialist breast care and research nurses' attitudes to adjuvant chemotherapy in older women with breast cancer. European Journal of Oncology Nursing. February 2012;16(1):78-86. E-Published 7th May 2011 ahead of print.doi:10.1016/j.ejon.2011.03.011