PMID- 33760077
OWN - NLM
STAT- MEDLINE
DCOM- 20211004
LR  - 20230801
IS  - 1365-2168 (Electronic)
IS  - 0007-1323 (Print)
IS  - 0007-1323 (Linking)
VI  - 108
IP  - 5
DP  - 2021 May 27
TI  - Bridging the age gap in breast cancer: cluster randomized trial of two decision 
      support interventions for older women with operable breast cancer on quality of 
      life, survival, decision quality, and treatment choices.
PG  - 499-510
LID - 10.1093/bjs/znab005 [doi]
AB  - BACKGROUND: Rates of surgery and adjuvant therapy for breast cancer vary widely 
      between breast units. This may contribute to differences in survival. This 
      cluster RCT evaluated the impact of decision support interventions (DESIs) for 
      older women with breast cancer, to ascertain whether DESIs influenced quality of 
      life, survival, decision quality, and treatment choice. METHODS: A multicentre 
      cluster RCT compared the use of two DESIs against usual care in treatment 
      decision-making in older women (aged at least >/=70 years) with breast cancer. Each 
      DESI comprised an online algorithm, booklet, and brief decision aid to inform 
      choices between surgery plus adjuvant endocrine therapy versus primary endocrine 
      therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome 
      was quality of life. Secondary outcomes included decision quality measures, 
      survival, and treatment choice. RESULTS: A total of 46 breast units were 
      randomized (21 intervention, 25 usual care), recruiting 1339 women (670 
      intervention, 669 usual care). There was no significant difference in global 
      quality of life at 6 months after the baseline assessment on intention-to-treat 
      analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; 
      P = 0.900). In women offered a choice of primary endocrine therapy versus surgery 
      plus endocrine therapy, knowledge about treatments was greater in the 
      intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was 
      altered, with a primary endocrine therapy rate among women with oestrogen 
      receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per 
      cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; 
      P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 
      per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; 
      P = 0.013). Survival was similar in both arms. CONCLUSION: The use of DESIs in 
      older women increases knowledge of breast cancer treatment options, facilitates 
      shared decision-making, and alters treatment selection. Trial registration 
      numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 
      (http://www.controlled-trials.com).
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of BJS 
      Society Ltd.
FAU - Wyld, L
AU  - Wyld L
AD  - Department of Oncology and Metabolism, University of Sheffield Medical School, 
      Sheffield, UK.
FAU - Reed, M W R
AU  - Reed MWR
AUID- ORCID: 0000-0001-7442-2132
AD  - Brighton and Sussex Medical School, Falmer, Brighton, UK.
FAU - Collins, K
AU  - Collins K
AD  - College of Health, Wellbeing and Life Sciences, Department of Allied Health 
      Professions, Sheffield Hallam University, Sheffield, UK.
FAU - Burton, M
AU  - Burton M
AD  - College of Health, Wellbeing and Life Sciences, Department of Allied Health 
      Professions, Sheffield Hallam University, Sheffield, UK.
FAU - Lifford, K
AU  - Lifford K
AD  - Division of Population Medicine, Cardiff University, Cardiff, UK.
FAU - Edwards, A
AU  - Edwards A
AD  - Division of Population Medicine, Cardiff University, Cardiff, UK.
FAU - Ward, S
AU  - Ward S
AUID- ORCID: 0000-0002-3344-0913
AD  - Department of Health Economics and Decision Science, School for Health and 
      Related Research, ScHARR, University of Sheffield, Sheffield, UK.
FAU - Holmes, G
AU  - Holmes G
AUID- ORCID: 0000-0002-8861-9638
AD  - Department of Health Economics and Decision Science, School for Health and 
      Related Research, ScHARR, University of Sheffield, Sheffield, UK.
FAU - Morgan, J
AU  - Morgan J
AUID- ORCID: 0000-0002-5337-5581
AD  - Department of Oncology and Metabolism, University of Sheffield Medical School, 
      Sheffield, UK.
FAU - Bradburn, M
AU  - Bradburn M
AD  - Clinical Trials Research Unit, School for Health and Related Research, University 
      of Sheffield, Sheffield, UK.
FAU - Walters, S J
AU  - Walters SJ
AD  - Clinical Trials Research Unit, School for Health and Related Research, University 
      of Sheffield, Sheffield, UK.
FAU - Ring, A
AU  - Ring A
AD  - Royal Marsden Hospital NHS Foundation Trust, London, UK.
FAU - Robinson, T G
AU  - Robinson TG
AD  - Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, 
      University of Leicester, Cardiovascular Research Centre, Glenfield General 
      Hospital, Leicester, UK.
FAU - Martin, C
AU  - Martin C
AD  - Department of Oncology and Metabolism, University of Sheffield Medical School, 
      Sheffield, UK.
FAU - Chater, T
AU  - Chater T
AD  - Clinical Trials Research Unit, School for Health and Related Research, University 
      of Sheffield, Sheffield, UK.
FAU - Pemberton, K
AU  - Pemberton K
AD  - Clinical Trials Research Unit, School for Health and Related Research, University 
      of Sheffield, Sheffield, UK.
FAU - Shrestha, A
AU  - Shrestha A
AD  - Department of Oncology and Metabolism, University of Sheffield Medical School, 
      Sheffield, UK.
FAU - Nettleship, A
AU  - Nettleship A
AD  - EpiGenesys, University of Sheffield, Sheffield, UK.
FAU - Murray, C
AU  - Murray C
AUID- ORCID: 0000-0001-6939-4384
AD  - EpiGenesys, University of Sheffield, Sheffield, UK.
FAU - Brown, M
AU  - Brown M
AD  - EpiGenesys, University of Sheffield, Sheffield, UK.
FAU - Richards, P
AU  - Richards P
AD  - Department of Health Economics and Decision Science, School for Health and 
      Related Research, ScHARR, University of Sheffield, Sheffield, UK.
FAU - Cheung, K L
AU  - Cheung KL
AD  - University of Nottingham, Royal Derby Hospital, Derby, UK.
FAU - Todd, A
AU  - Todd A
AD  - Department of Oncology and Metabolism, University of Sheffield Medical School, 
      Sheffield, UK.
FAU - Harder, H
AU  - Harder H
AD  - Brighton and Sussex Medical School, Falmer, Brighton, UK.
FAU - Brain, K
AU  - Brain K
AD  - Division of Population Medicine, Cardiff University, Cardiff, UK.
FAU - Audisio, R A
AU  - Audisio RA
AUID- ORCID: 0000-0002-7538-4809
AD  - University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden.
FAU - Wright, J
AU  - Wright J
AD  - Brighton and Sussex Medical School, Falmer, Brighton, UK.
FAU - Simcock, R
AU  - Simcock R
AD  - Brighton and Sussex Medical School, Falmer, Brighton, UK.
FAU - Armitage, F
AU  - Armitage F
AD  - Weston Park Hospital, Sheffield, UK.
FAU - Bursnall, M
AU  - Bursnall M
AD  - Clinical Trials Research Unit, School for Health and Related Research, University 
      of Sheffield, Sheffield, UK.
FAU - Green, T
AU  - Green T
AD  - Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK.
FAU - Revell, D
AU  - Revell D
AD  - Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK.
FAU - Gath, J
AU  - Gath J
AD  - Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK.
FAU - Horgan, K
AU  - Horgan K
AD  - Department of Breast Surgery, Bexley Cancer Centre, St James's University 
      Hospital, Leeds, UK.
FAU - Holcombe, C
AU  - Holcombe C
AD  - Liverpool University Hospitals Foundation Trust, Liverpool, UK.
FAU - Winter, M
AU  - Winter M
AD  - Weston Park Hospital, Sheffield, UK.
FAU - Naik, J
AU  - Naik J
AD  - Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK.
FAU - Parmeshwar, R
AU  - Parmeshwar R
AD  - University Hospitals of Morecambe Bay, Lancaster, UK.
FAU - Gosney, M
AU  - Gosney M
AD  - Royal Berkshire NHS Foundation Trust, Reading, UK.
FAU - Hatton, M
AU  - Hatton M
AD  - Weston Park Hospital, Sheffield, UK.
FAU - Thompson, A M
AU  - Thompson AM
AD  - Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Pragmatic Clinical Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Br J Surg
JT  - The British journal of surgery
JID - 0372553
RN  - 0 (Antineoplastic Agents, Hormonal)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents, Hormonal/therapeutic use
MH  - Breast Neoplasms/mortality/*therapy
MH  - Chemotherapy, Adjuvant
MH  - *Decision Making
MH  - *Decision Support Techniques
MH  - Female
MH  - Health Knowledge, Attitudes, Practice
MH  - Humans
MH  - Quality of Life
PMC - PMC10364907
EDAT- 2021/03/25 06:00
MHDA- 2021/10/05 06:00
PMCR- 2021/03/23
CRDT- 2021/03/24 12:55
PHST- 2020/06/08 00:00 [received]
PHST- 2020/10/04 00:00 [revised]
PHST- 2020/12/28 00:00 [accepted]
PHST- 2021/03/25 06:00 [pubmed]
PHST- 2021/10/05 06:00 [medline]
PHST- 2021/03/24 12:55 [entrez]
PHST- 2021/03/23 00:00 [pmc-release]
AID - 6182547 [pii]
AID - znab005 [pii]
AID - 10.1093/bjs/znab005 [doi]
PST - ppublish
SO  - Br J Surg. 2021 May 27;108(5):499-510. doi: 10.1093/bjs/znab005.