Prospective Integration of Patient Preferences Into Adjuvant Therapy Decisions for Older Women With Early-Stage Hormone Receptor-Positive Breast Cancer Adjuvant Therapy Decisions in Breast Cancer.

Abstract

Guidelines for women aged ≥65 years with early-stage, hormone receptor-positive cancer allow for a range of adjuvant strategies following breast-conserving surgery. These include hormone therapy (HT) with or without radiation therapy (RT), RT alone if HT is not desired or feasible, or even no adjuvant therapy. Although these options offer flexibility, they can also create uncertainty. To address this, we implemented a simple multidisciplinary clinic (s-MDC) with same-day medical and radiation oncology consultations, alongside a previsit questionnaire assessing decision-making preferences and treatment attitudes. We evaluated 95 patients aged ≥65 years with stage I, hormone receptor-positive breast cancer seen in the s-MDC from August 2020 to December 2023. All completed the Decision Autonomy Preference Scale, Medical Maximizing-Minimizing Scale, and e-Prognosis 10-year mortality risk estimates. We retrospectively reviewed demographics, clinical variables, and chosen treatments, examining associations using χ² tests, t tests, and regressions. Among 95 patients, adjuvant treatments included no therapy (16.8%), HT alone (16.8%), RT alone (20.0%), and HT+RT (45.3%). Older age, higher mortality risk, and a preference for decision autonomy correlated with omission of all therapy or omission of HT. "Minimizers" favored HT alone, whereas "maximizers" often chose RT or HT+RT. Neither baseline patient-reported data nor most clinicopathologic factors predicted the use of RT alone. The only clinicopathologic factor associated with choice was tumor size: patients with larger (T1b/T1c) tumors more commonly received HT+RT. In this s-MDC setting, treatment decisions were driven largely by patient preferences, life expectancy, and treatment inclinations, rather than by baseline patient-reported measures or tumor features. These findings underscore the importance of integrating patient values into decision-making and support further research into RT-alone approaches for those forgoing HT, given the prevalence of this treatment choice.