了解乳腺癌老年妇女的治疗决策:一项基于调查的研究
Ruby J Kazemi1, Callie VanWinkle1, Cecilia M Pesavento2
1University of Michigan Medical School, Ann Arbor, Michigan.
The Journal of surgical research
|February 6, 2024
概括
患有早期乳腺癌的老年妇女经常接受不必要的治疗,如哨兵淋巴结活检和放射治疗,尽管指南建议不要这样做. 患者的决策与生存优先事项保持一致,而不是化品或成本问题.
科学领域:
- 在瘤学瘤学.
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 国家指导方针建议在70岁以上的女性中省略哨兵淋巴结活检 (SLNB) 和淋巴切除术后放射治疗,这些女性患有早期激素受体阳性,HER2阴性乳腺癌.
- 国家数据显示,这些治疗方法经常被使用,这表明过度使用.
- 影响治疗决策的患者层面因素需要探索.
研究的目的:
- 调查导致SLNB和放射治疗在早期乳腺癌老年妇女过度使用的以患者为中心的因素.
- 了解患者价值观与追求的治疗方法之间的对齐.
主要方法:
- 对70岁以上的女性进行了一项探索性横截面调查,这些女性因早期激素受体阳性/HER2阴性乳腺癌接受过手术.
- 该调查收集了关于提供的/追求的治疗方法的数据,以患者为中心的结果的重要性,以及它们对决策的影响.
- 用描述性统计数据来分析调查数据.
主要成果:
- 达到了61%的应答率 (31/51名患者).
- 大多数患者 (86%) 进行了隆瘤切除;然而,28%的患者接受了SLNB,56%的隆瘤切除患者接受了辅助放射治疗.
- 患者优先考虑整体存活率,乳腺特异性存活率和局部复发预防,而不是化品的结果,成本或避免内分泌治疗.
结论:
- 患者的治疗决策与他们的声明值相关,特别是生存率和复发预防.
- 这表明SLNB和放射治疗对死亡率的感知有好处,即使当被认为是低价值护理时也是如此.
- 结果支持有针对性的干预措施,包括患者教育和工具,以消除低价值的乳腺癌护理.
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