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Little is known about what constitutes appropriate care for older women with breast cancer. Extending work begun as part of an National Cancer Initute-funded project, we are examining whether variations in care received by older women affect short-term psychosocial and clinical outcomes. Our specific aims are: (1) To describe patterns of adjuvant hormonal and chemotherapy in older women, and factors associated with receipt of these therapies; (2) To characterize and quantify the breast cancer-related care received by older women during the early years following diagnosis; and (3) To determine the effects of ongoing breast cancer care on patients' quality of life. We are conducting a longitudinal observational study of a cohort of 302 women greater than or equal 55 years of age diagnosed with stage I and II breast cancer between October 1992 and December 1995 at five sites in Boston, Massachusetts. Women are interviewed annually to obtain information about health and personal characteristics. Medical record abstracts are performed annually to gather information about treatments received, tests performed, and disease recurrences. Descriptive and multivariate analytic techniques will be used to identify patient and provider characteristics associated with variations in care received and the effects of these variations on patients quality of life.
Abstract: An urgent need exists to reduce elderly women's risk for breast cancer by promoting a health behavior that could lower this threat. The knowledge of breast self-examination could represent a health behavior that leads to the detection of advanced breast cancer and could influence elderly women's self-rated health status. The focus of this study was to determine if the knowledge of breast self-examination (BSE) as an adaptive health behavior can influence the self-rated health status of elderly women. Additional factors were also considered for the extent of their potential influence on an elderly woman's estimate of health. The purpose of this research was to study the relationship of breast cancer risk, knowledge of BSE, environmental press, and individual competence factors on the self-rated health status of women, age 75 years and older, residing in a group of assisted living facilities. This study looked at whether BSE knowledge could be a significant contributor to these women's self-rated health status. This research was conducted with a quasi-experimental design and used random assignment to place assisted living facilities in either treatment or control groups. On the participant level, older women were provided with their risk of breast cancer prior to the intervention. In addition, the experimental group of older women received BSE instruction and then 8 weeks later were surveyed as to their health. Likewise, the control group provided the same data, except BSE instruction was withheld. A t-test was done to check for differences between the groups as well as a correlation to gauge relationships between the independent variables and the dependent variable for each of the groups. Finally, a step-wise linear regression was preformed to find which of the independent variables best explained the most variance in the dependent variable for each of the groups. BSE knowledge was shown to contribute statistically to the experimental older women's self rated mental health scores. Independent activities of daily living were statistically significant for both groups at explaining variance in their physical health scores. Independence also was indicated as being important in explaining variance in the mental health score of the experimental group.
I was looking at Mrs T – all 45 kilos of her – with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, “because it was making her tired.” As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T’s kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? “Physicians,” said Voltaire, “pour drugs they know little for diseases they know even less into patients they know no- ing about.” Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.
This book offers evidence-based clinical knowledge of older patients suffering from breast cancer. It details the full armament of therapeutic options as well as the epidemiology of the disease and specific psychosocial considerations for elderly patients.
Age-related health disparities in breast cancer screening are a public health concern. From 2002 to 2006, the median age for newly diagnosed cases of breast cancer was 61 years and the median age for breast cancer mortality was 68 years of age (Surveillance Epidemiology and End Results [SEER], 2009). Mammography is the best available screening tool for breast cancer detection (Susan G. Komen Foundation, 2008). The Centers for Medicare and Medicaid Services (CMS, 2006) reported that only about half of older women who are eligible for mammograms through Medicare obtain a mammogram every two years. The literature identifies psychosocial barriers, including a lack of breast cancer knowledge and cancer fatalism, as independent predictors of mammography participation among older women. The purpose of this quasi-experimental study was to determine the effects of a breast health awareness program on older women's knowledge of and fatalistic attitudes toward breast cancer and breast cancer screening and on their participation in mammography screening. Sixty women over 65 years of age will be recruited from 4 senior nutrition programs located in underserved areas of San Diego County to participate in a breast health awareness program. Data will be collected using a demographic questionnaire, pre and postintervention revised Powe Fatalism Inventory, and a breast health knowledge questionnaire. Descriptive statistics will be used to analyze the relationship of fatalism to breast cancer knowledge and the relationships of knowledge and fatalism to mammography participation. The potential impact of the intervention will lie in earlier diagnosis of breast cancer disease in older women through improved screening participation, resulting in decreased breast cancer mortality among older women in San Diego County.
The results of randomized trials evaluating the use of early or adjuvant systemic treatment for patients with resectable breast cancer provide an eloquent rebuttal to those who would argue that we have made no progress in the treatment of cancer. Many of the tumors that we have been most successful in curing with chemotherapy and other newer forms of treatment are relatively uncommon. In contrast, breast cancer continues to be the single most common malignancy among women in the western world, is increasingly a cause of death throughout Asia and Third-World countries, and remains one of the most substantial causes of cancer mortality world wide. The use of mammography as a means of early detection has been shown to reduce breast cancer mortality by 25-35% among those popu lations in which it is utilized. The use of adjuvant systemic treatment in appropriate patients provides a similar (and additional) reduction in breast cancer mortality. Few subjects have been so systematically studied in the history of medicine, and it seems fair to conclude that the value to adjuvant systemic therapy in prolonging the lives of women with breast cancer is more firmly supported by empirical evidence than even the more conventional or primary treatments using various combinations ofsurgery and radiotherapy.
The number of Americans 65 years of age or older is projected to more than double to over 98 million by 2060, making them 24% of the overall population. Women constitute more than 50% of this group. Most clinicians who provide primary care for older women receive minimal training about their unique health issues and needs during residency however, and few resources exist to guide them regarding these issues in practice. This book provides user-friendly, evidence-based guidance to manage common challenges in healthcare for women during menopause and beyond, filling a huge and growing unmet need for primary care clinicians. Edited by a multidisciplinary team with content expert authors from family medicine, oncology, urogynecology, obstetrics and gynecology, psychology, and more, this text provides clinically relevant information about important conditions impacting the health of older women, including suggested guidelines for management and helpful resources for patient counselling and care. The first half of the book covers general topics such as menopause, bone health, depression and grief, cancer survivorship, and obesity. The second half focuses on issues below the belt that are difficult to talk about, such as incontinence, vulvar pathology, and sexual health after menopause. While there is copious literature about the menopausal transition, few resources for clinicians exist about caring for women beyond the 6th decade. Challenges in Older Women’s Health: A primer for clinicians provides focused, evidence-based information about high-yield topics for a too often neglected group of patients.