Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals

Morrow, E. S., Dolan, R. D. , Doughty, J., Stallard, S., Lannigan, A. and Romics, L. (2019) Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals. Breast Cancer: Targets and Therapy, 11, pp. 179-188. (doi: 10.2147/BCTT.S194124)

Abstract

Introduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found. Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams. Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures. Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Romics, Mr Laszlo and Morrow, Dr Elizabeth and Doughty, Miss Julie and Dolan, Dr Ross and Lannigan, Mrs Alison
• Authors: Morrow, E. S., Dolan, R. D., Doughty, J., Stallard, S., Lannigan, A., and Romics, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Breast Cancer: Targets and Therapy
• Publisher: Dove Medical Press
• ISSN: 1179-1314
• ISSN (Online): 1179-1314
• Copyright Holders: Copyright © 2019 Morrow et al.
• First Published: First published in Breast Cancer: Targets and Therapy 11: 178-188
• Publisher Policy: Reproduced under a Creative Commons License