Morgan Jenna L, Shrestha Anne, Martin Charlene, Walters Stephen, Bradburn Michael, Reed Malcolm, Robinson Thompson G, Cheung Kwok-Leung, Audisio Riccardo, Gath Jacqui, Revell Deirdre, Green Tracy, Ring Alistair, Lifford Kate J, Brain Katherine, Edwards Adrian, Wyld Lynda
Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
Division of Clinical Medicine, Faculty of Health, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
J Geriatr Oncol. 2025 May;16(4):102226. doi: 10.1016/j.jgo.2025.102226. Epub 2025 Mar 25.
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.
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.
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.
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.
ISRCTN: 46099296.
在癌症治疗的决策过程中，常常需要在生活质量（QoL）和生命长度之间进行权衡。对于因年龄和合并症而预期寿命有限的患者，这可能会变得复杂。患有早期乳腺癌的老年女性通常会接受非标准治疗（主要是内分泌治疗[PET]或省略化疗或放疗），以降低治疗的发病率并维持生活质量。我们旨在确定患有早期（潜在可治愈）乳腺癌的老年女性在治疗决策中对生活质量与生命长度的相对影响。
这是年龄差距多中心队列研究的一项子研究，该研究前瞻性招募了70岁以上的早期乳腺癌女性。在主要研究的一个子集中，分析了基线人口统计学、健康特征和生活质量评分，并使用一份定制问卷来评估生活质量和生命长度偏好，包括经过验证的质量/数量问卷的修改版本。
问卷被发送给308名患者，194名（63%）参与者回复，中位年龄为75岁（范围70 - 93岁）。其中，14名接受了PET治疗，180名接受了标准治疗（ST）（手术±辅助治疗），包括37名接受化疗的患者。PET组年龄更大（中位年龄83.5岁对76岁），健康状况更差（9/14；64.3%的患者有一种或多种合并症，而69/144；47.9%），基线身体领域生活质量评分更低。接受PET治疗的患者对生活质量和生命长度的重视程度相同（Q评分为0.87，L评分为0.91），而接受化疗的患者更看重生命长度而非生活质量（Q评分为0.67，L评分为0.86）。亚组分析显示年龄增长与生活质量偏好之间存在小的相关性（斯皮尔曼相关系数r = 0.2，P < 0.009）。合并症、虚弱或总体生活质量与生命长度/生活质量偏好之间没有相关性。
患有早期乳腺癌的老年女性高度重视生命长度和生活质量，生活质量偏好与不太积极的治疗选择之间存在关联。相对生活质量偏好随着年龄增长而增加。需要更多研究来确定治疗后的生活质量决定因素和结果，以帮助患者做出反映其优先事项的决策。
ISRCTN：46099296。
