Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals

Elizabeth S Morrow,1 Ross D Dolan,1 Julie Doughty,2 Sheila Stallard,2 Alison Lannigan,3 Laszlo Romics1,41Academic Unit of Surgery, University of Glasgow, Glasgow, UK; 2Department of Surgery, Gartnavel General Hospital, Glasgow, UK; 3Department of Surgery, Wishaw General Hospital, Lanarkshire, UK; 4D...

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Autores principales:	Morrow ES, Dolan RD, Doughty J, Stallard S, Lannigan A, Romics L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	breast cancer elderly mastectomy breast conserving surgery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/941650c731c04e43a3e21b522405cad6
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spelling	oai:doaj.org-article:941650c731c04e43a3e21b522405cad62021-12-02T09:02:52ZVariation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals1179-1314https://doaj.org/article/941650c731c04e43a3e21b522405cad62019-05-01T00:00:00Zhttps://www.dovepress.com/variation-in-the-management-of-elderly-patients-in-two-neighboring-bre-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Elizabeth S Morrow,1 Ross D Dolan,1 Julie Doughty,2 Sheila Stallard,2 Alison Lannigan,3 Laszlo Romics1,41Academic Unit of Surgery, University of Glasgow, Glasgow, UK; 2Department of Surgery, Gartnavel General Hospital, Glasgow, UK; 3Department of Surgery, Wishaw General Hospital, Lanarkshire, UK; 4Department of Surgery, New Victoria Hospital, Glasgow, UKIntroduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found.Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams.Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures.Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.Keywords: breast cancer, old age, variation in treatmentMorrow ESDolan RDDoughty JStallard SLannigan ARomics LDove Medical Pressarticlebreast cancerelderlymastectomybreast conserving surgeryNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 11, Pp 179-188 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	breast cancer elderly mastectomy breast conserving surgery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	breast cancer elderly mastectomy breast conserving surgery Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Morrow ES Dolan RD Doughty J Stallard S Lannigan A Romics L Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
description	Elizabeth S Morrow,1 Ross D Dolan,1 Julie Doughty,2 Sheila Stallard,2 Alison Lannigan,3 Laszlo Romics1,41Academic Unit of Surgery, University of Glasgow, Glasgow, UK; 2Department of Surgery, Gartnavel General Hospital, Glasgow, UK; 3Department of Surgery, Wishaw General Hospital, Lanarkshire, UK; 4Department of Surgery, New Victoria Hospital, Glasgow, UKIntroduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found.Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams.Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures.Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.Keywords: breast cancer, old age, variation in treatment
format	article
author	Morrow ES Dolan RD Doughty J Stallard S Lannigan A Romics L
author_facet	Morrow ES Dolan RD Doughty J Stallard S Lannigan A Romics L
author_sort	Morrow ES
title	Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
title_short	Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
title_full	Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
title_fullStr	Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
title_full_unstemmed	Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
title_sort	variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/941650c731c04e43a3e21b522405cad6
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Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals

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