Elderly Patient Involvement in the Decision-Making Process of Breast Cancer Management in Kuwait

Worldwide statistics highlight that around 40% of breast cancer cases occur in patients aged 65 years and above, with expectations that this will increase as the population gets older. Cancer management in elderly patients is still unclear and depends primarily on individual oncologist decisions. The literature suggests that elderly breast cancer patients receive less intensive chemotherapy than younger patients, which is mainly attributed to a lack of effective individualized assessment or age bias. The current study explored the impact of elderly patient involvement in the decision-making process of breast cancer management and less intensive treatment allocation in Kuwait.

In an observational exploratory populationbased study, 60 newly diagnosed breast cancer patients aged 60 years and above and candidates for chemotherapy were included. Patients were grouped based on the treating oncologists' decision to receive either intensive first-line chemotherapy (standard treatment) or less intensive/ other than first-line chemotherapy (non-standard treatment) according to standardized international guidelines recommendations. Patients' attitudes toward the recommended treatment (accept/ reject) were documented through a short semi-structured interview. The prevalence of patients' interference with the treatment was reported, and individual causes were investigated.

Data showed that 58.8% and 41.2% of elderly patients were allocated for intensive and less intensive treatment, respectively. Overall, 15% of patients interfered with the treatment plan against their oncologists' recommendations even though they were allocated for less intensive treatment. Among those, 6.7% of patients rejected the recommended treatment, 3.3% delayed initiating treatment, and 5% received <3 cycles of chemotherapy but refused to continue cytotoxic treatment. None of the patients requested intensive treatment. This interference was mainly directed by cytotoxic treatment toxicity concerns and targeted treatment preference.

In clinical practice, oncologists allocate selected breast cancer patients aged 60 years and above for less intensive cytotoxic treatment to enhance their tolerance; however, this was not always associated with patients' acceptance and compliance. Lack of awareness of targeted treatment indications and utilization directed 15% of patients to reject, delay, or refuse to continue the recommended cytotoxic treatment against their oncologists' recommendations.