A qualitative study of factors affecting chemotherapy use in older women with breast cancer: barriers, promoters, and implications for intervention

Abstract

Study objective: The incidence of breast cancer increases with advancing age and yet women 65 and older (hereinafter referred to as 'older' women) do not always receive the most intensive treatments, such as adjuvant chemotherapy. The causes of underutilization of chemotherapy in this age group are poorly delineated. The purpose of the study was to explore older breast cancer patients' attitudes towards chemotherapy and factors that influenced their decisions to use or not use this treatment modality.

Design: Qualitative methods were used to conduct race/ethnicity-specific focus groups. A thematic analysis was performed using NVIVO.

Setting and participants: Drawn from the Washington, DC area, participants were 34 ethnically diverse older breast cancer survivors (18 Caucasians, 10 African-Americans, and 6 Latinas). Focus groups were conducted in a local church; a senior center, and the Lombardi Cancer Center.

Main results: Results showed that many women felt they had no 'choice' and did what the doctor told them to do. For those who reported participation in the decision, time spent exchanging information with the woman's physician and the inclusion of family members promoted perceptions of optimum decision-making leading to the use of chemotherapy. Two barriers to using chemotherapy were negative expectations about side effects and lack of information specific to the woman's individuals' circumstances. Women of color reported less physician communication and information, in part due to language difficulties and perceived bias; these factors acted as barriers to chemotherapy.

Conclusion: Physicians could provide specific and limited information to patients and family members to promote realistic expectations and optimum decisions about chemotherapy, given the risks involved in this treatment modality. Interventions should be developed and tested to enhance communication that is sensitive to older women's culture, family structure, illness experiences, preferences, and expectations.