Husain Lopa Sadia, Collins Karen, Reed Malcolm, Wyld Lynda
Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK.
Psychooncology. 2008 Apr;17(4):410-6. doi: 10.1002/pon.1242.
Primary endocrine therapy (PET) is the treatment of primary, operable breast cancer with drugs, such as tamoxifen, rather than surgery. It is in widespread use in the UK with 40% of women over 70 years old being treated in this way. PET is associated with inferior rates of local control compared with the standard surgical therapies, but there is no difference in overall survival. There has been no published research regarding the attitudes of older women concerning these two alternative approaches to treatment; what may influence their treatment choice or their experience of either treatment modality. This study aimed to address these questions.
In-depth qualitative interviews were undertaken to explore the views of a group of 21 purposively selected older women (>70 years old), who had been treated by PET or surgery for breast cancer. The interviews were transcribed verbatim and analysed using Framework Analysis.
Both surgery and PET were well tolerated and had high satisfaction ratings from most women. This was the case even for those who had complications following surgery or needed a change of management in the PET group. Older women expressed no age-specific fears for operative procedures. The women were passive information seekers and relied heavily on 'expert' advice in making their treatment choices. Neither social support or age were factors in their decision-making. Their main concern was to ensure that their quality of life and independence remained unaffected.
Older women have no strong preference for either treatment option but are concerned that the treatment is effective and causes minimal disruption to their quality of life and independence. This study suggests that medical consultations may need to be adapted to reflect the passive acceptance of 'expert' advice in the majority of women in this age group.
原发性内分泌治疗（PET）是指使用他莫昔芬等药物而非手术来治疗原发性可手术乳腺癌。在英国，这种疗法被广泛应用，70岁以上的女性中有40%接受这种治疗方式。与标准手术治疗相比，PET的局部控制率较低，但总体生存率并无差异。关于老年女性对这两种替代治疗方法的态度，尚无已发表的研究；哪些因素可能影响她们的治疗选择或她们对任何一种治疗方式的体验。本研究旨在解决这些问题。
对一组21名经过目的性选择的老年女性（年龄>70岁）进行了深入的定性访谈，这些女性曾接受过PET或手术治疗乳腺癌。访谈内容逐字转录，并采用框架分析法进行分析。
手术和PET的耐受性都很好，大多数女性对它们的满意度都很高。即使是那些手术后出现并发症或在PET组中需要改变治疗方案的女性也是如此。老年女性对手术操作没有特定年龄的恐惧。这些女性是被动的信息寻求者，在做出治疗选择时严重依赖“专家”建议。社会支持和年龄都不是她们决策的因素。她们主要关心的是确保自己的生活质量和独立性不受影响。
老年女性对这两种治疗方案都没有强烈的偏好，但担心治疗有效且对她们的生活质量和独立性造成的干扰最小。本研究表明，医疗咨询可能需要做出调整，以反映该年龄组大多数女性对“专家”建议的被动接受。
