Towards an optimal multidisciplinary approach to breast cancer treatment for older women

Nemica Thavarajah, Ines Menjak, Maureen Trudeau, Rajin Mehta, Frances Wright, Angela Leahey, Janet Ellis, Damian Gallagher, Jennifer Moore, Bonnie Bristow, Noreen Kay, Ewa Szumacher

Abstract


The treatment of breast cancer presents specific concerns that are unique to the needs of older female patients. While treatment of early breast cancer does not vary greatly with age, the optimal management of older women with breast cancer often requires complex interdisciplinary supportive care due to multiple comorbidities. This article reviews optimal approaches to breast cancer in women 65 years and older from an interdisciplinary perspective. A literature review was conducted using MEDLINE and EMBASE, choosing articles concentrated on the management of older breast cancer patients from the point of view of several disciplines, including geriatrics, radiation oncology, medical oncology, surgical oncology, psycho-oncology, palliative care, nursing, and social work. This patient population requires interprofessional collaboration from the time of diagnosis, throughout treatment and into the recovery period. Thus, we recommend an interdisciplinary program dedicated to the treatment of older women with breast cancer to optimize their cancer care.

Key words: breast cancer, older women, multidisciplinary, breast cancer treatment


Full Text:

PDF

References


American Cancer Society. (2011). Cancer facts & figures 2011. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf

American Cancer Society. (2012). Breast cancer facts and figures 2011–2012. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-030975.pdf

Anderson, B.O., Kaufman, C.S., Kiel, K.D., & Carlson, R.W. (2008). Interdisciplinary coordination for breast healthcare. Disease Management & Health Outcomes, 16(1), 7–11.

Bajetta, E., Procopio, G., Celio, L., Gattinoni, L., Della Torre, S., Mariani, L., et al. (2005). Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. Journal of Clinical Oncology, 23(10), 2155-2161.

Balducci, L., Colloca, G., Cesari, M., & Gambassi, G. (2010). Assessment and treatment of elderly patients with cancer. Surgical Oncology, 19(3), 117-123.

Bellera, C.A., Rainfray, M., Mathoulin-Pélissier, S., Mertens, F.D., Fonck, M., & Soubeyran, P.L. (2012). Screening older cancer patients: First evaluation of the G-8 geriatric screening tool. Annals of Oncology, 23, 2166–2172.

Bergman, H., Ferrucci, L., Guralnik, J., Hogan, D.B., Hummel, S., Karunananthan, S., et al. (2007). Frailty: An emerging research and clinical paradigm--issues and controversies. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 62(7), 731–737.

Bettevy, F., Dufranc, C., & Hofmann, G. (2006). Critères de qualité de l’annonce du diagnostic: point de vue des maladies et de la Ligne nationale contre le cancer. Risques et Qualité, 3(2), 67–72.

Biganzoli, L., Licitra, S., Claudino, W., Pestrin, M., & Leo, A.D. (2007). Clinical decision making in breast cancer: TAM and aromatase inhibitors for older patients—A jungle? European Journal of Cancer, 43(15), 2270–2278.

Biganzoli, L., Wildiers, H., Oakman, C., Marotti, L., Loibl, S., Kunkler, I., et al. (2012). Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncology, 13(4), e148–60.

Bouchardy, C., Rapiti, E., Blagojevic, S., Vlastos, A.T., & Vlastos, G. (2007). Older female cancer patients: importance, causes, and consequences of undertreatment. Journal of Clinical Oncology, 25(14), 1858–1869.

Braes, T., Flamaing, J., Sterckx, W., Lipkens, P., Sabbe, M., de Rooij, S.E., et al. (2009). Predicting the risk of functional decline in older patients admitted to the hospital: A comparison of three screening instruments. Age and Ageing, 38, 600–603.

Brollo, J., Curigliano, G., Disalvatore, D., Marrone, B.F., Criscitiello, C., Bagnardi, V., et al. (2013). Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: A systematic review of randomized controlled trials. Cancer Treatment Reviews, 39(1), 44–50.

Canadian Association of Nurses in Oncology (CANO/ACIO). (2006). Practice Standards and Competencies for the Specialized Oncology Nurse. Retrieved from http://www,cabi-acio.ca/%7EASSETS/DOCUMENT/Practice/CONEP_Standards2006September28_REVISEDFor_20Website.pdf

Chaudry S.I., McAvay, G., Nig, Y., Allore, H.G., Newman, A.B., & Gill, T.M. (2012). Risk factors for onset of disability among older persons newly diagnosed with heart failure: The Cardiovascular Health Study. Journal of Cardiac Failure, 17(9), 764–770.

Christiansen, P., Bjerre, K., Ejlertsen, B., Jensen, M.B., Rasmussen, B.B., Laenkholm, A.V., et al. (2011). Mortality rates among early-stage hormone receptor-positive breast cancer patients: A population-based cohort study in Denmark. Journal of the National Cancer Institute, 103(18), 1363–1372.

Clarke, M., Collins, R., Darby, S., Davies, C., Elphinstone, P., Evans, E., et al. (2005). Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet, 366(9503), 2087–2106.

Crivellari, D., Aapro, M., Leonard, R., von Minckwitz, G., Brain, E., Goldhirsch, A., et al. (2007). Breast cancer in the elderly. Journal of Clinical Oncology, 25(14), 1882–1890.

Crivellari, D., Sun, Z., Coates, A.S., Price, K.N., Thurlimann, B., Mouridsen, H., et al. (2008). Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer: The BIG 1-98 trial. Journal of Clinical Oncology, 26(12), 1972–1979.

Crivellari, D., Gray, K.P., Dellapasqua, S., Puglisi, F., Ribi, K., Price, K.N., et al. (2013). Adjuvant pegylated liposomal doxorubicin for older women with endocrine nonresponsive breast cancer who are NOT suitable for a “standard chemotherapy regimen”: The CASA randomized trial. The Breast, 22(2), 130–137.

Darby, S., McGale, P., Correa, C., Taylor, C., Arriagada, R., Clarke, M., et al. (2011). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet, 378(9804), 1707–1716.

de Glas, N.A., van de Water, W., Engelhardt, E.G., Bastiaannet, E., de Craen, A.J., Kroep, J.R., et al. (2014). Validity of Adjuvant! Online program in older patients with breast cancer: A population-based study. Lancet Oncology, 15(7), 722–729.

Del Mastro, L., Perrone, F., Repetto, L., Manzione, L., Zagonel, V., Fratino, L., et al. (2005). Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: A phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). Annals of Oncology, 16(2), 253–258.

Deschodt, M., Wellens, N.I., Braes, T., De Vuyst, A., Boonen, S., Flamaing, P., et al. (2011). Prediction of functional decline in older hospitalized patients: A comparative multicenter study of three screening tools. Aging Clinical and Experimental Research, 23, 421–426.

Djulbegovic, B., Guyatt, G.H., & Ashcroft, R.E. (2009). Epistemological inquiries in evidence-based medicine. Cancer Control, 16(2), 2621–2632.

Du, X.L., Key, C.R., Osborne, C., Mahnken, J.D., & Goodwin, J.S. (2003). Discrepancy between consensus recommendations and actual community use of adjuvant chemotherapy in women with breast cancer. Annals of Internal Medicine, 138(2), 90–97.

Elkin, E.B., Hurria, A., Mitra, N., Schrag, D., & Panageas, K.S. (2006). Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: Assessing outcome in a population-based, observational cohort. Journal of Clinical Oncology, 24(18), 2757–2764.

Ellis, G., Mant, J., Langhorne, P., Dennis, M., & Winner, S. (2010). Stroke liaison workers for stroke patients and carers: An individual patient data meta-analysis. Cochrane Database of Systematic Reviews, (5), CD005066.

Extermann, M., Meyer, J., McGinnis, M., Crocker, T.T., Corcoran, M., Yoder, J., et al. (2004). A comprehensive geriatric intervention detects multiple problems in older breast cancer patients. Critical Reviews in Oncology Hematology, 49, 69–75.

Extermann, M., Boler, I., Reich, R.R., Lyman, G.H., Brown, R.H., DeFelice, J., et al. (2012). Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer, 118(13), 3377–3386.

Feher, O., Vodvarka, P., Jassem, J., Morack, G., Advani, S.H., Khoo, K.S., et al. (2005). First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: A multicenter, randomized, phase III study. Annals of Oncology, 16(6), 899–908.

Fisher, B., Bryant, J., Dignam, J.J., Wickerham, D.L., Mamounas, E.P., Fisher, E.R., et al. (2002). Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. Journal of Clinical Oncology, 20(20), 4141–4149.

Fitch, M. (2000). Supportive care for cancer patients. Hospital Quarterly, 3(4), 39–46.

Fitch, M.I. (2008). Supportive care framework. Canadian Oncology Nursing Journal, 18(1), 6-24.

Forrest, A.P., Stewart, H.J., Everington, D., Prescott, R.J., McArdle, C.S., Harnett, A.N., et al. (1996). Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet, 348(9029), 708–713.

Fyles, A.W., McCready, D.R., Manchul, L.A., Trudeau, M.E., Merante, P., Pintilie, M., et al. (2004). Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. New England Journal of Medicine, 351(10), 963–970.

Goldhirsch, A., Winer, E.P., Coates, A.S., Gelber, R.D., Piccart-Gebhart, M., Thurlimann, B., et al. (2013). Personalizing the treatment of women with early breast cancer: Highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Annals of Oncology, 24(9), 2206–2223.

Hamaker, M.E., Jonker, J.M., de Rooij, S.E., Vos, A.G., Smorenburg, C.H., & van Munster, B.C. (2012). Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: A systematic review. Lancet Oncology, 13(10), e437–44.

Hempenius, L., Slaets, J.P.J., van Asselt, D., de Bock, G.H., Wiggers, T., & van Leeuwen, B.L. (2013). Outcomes of a geriatric liaison intervention to prevent the development of postoperative delirium in frail elderly cancer patients: Report on a multicentre, randomized, controlled trial. PLoS ONE, 8(6), e64834.

Hind, D., Wyld, L., & Reed, M.W. (2007). Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: Cochrane review. British Journal of Cancer, 96(7), 1025–1029.

Hughes, K.S., Schnaper, L.A., Bellon, J.R., Cirrincione, C.T., Berry, D.A., McCormick, B., et al. (2013). Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: Long-term follow-up of CALGB 9343. Journal of Clinical Oncology, 31(19), 2382–2387.

Hurria, A., Togawa, K., Mohile, S.G., Owusu, C., Klepin, H.D., Gross, C.P., et al. (2011). Predicting chemotherapy toxicity in older adults with cancer: A prospective multicenter study. Journal of Clinical Oncology, 29(25), 3457–3465.

Jüni, P., Holenstein, F., Sterne, J., Bartlett, C., & Egger, M. (2002). Direction and impact of language bias in meta-analyses of controlled trials: Empirical study. International Journal of Epidemiology, 31(1), 115–123.

Kenis, C., Geeraerts, A., Braes, T., Milisen, K., Flamaing, J., & Wildiers, H. (2006). The Flemish version of the Triage Risk Screening Tool (TRST): A multidimensional short screening tool for the assessment of elderly patients. Critical Review in Oncology Hematology, 60(Suppl.), S31.

Kenis, C., Bron, D., Libert, Y., Decoster, L., Van Puyvelde, K., Scalliet, P., et al. (2013). Relevance of a systematic geriatric screening and assessment in older patients with cancer: Results of a prospective multicentric study. Annals of Oncology, 24(5), 1306–1312.

Kunkler, I.H., Williams, L.W., Jack, W., Canney, P., Prescott, R.J., & Dixon, M.J. (2013). The PRIME II trial: Wide local excision and adjuvant hormonal therapy + postoperative whole breast irradiation in women > 65 years with early breast cancer managed by breast conservation. Cancer Research, 73(24 Suppl. 1).

Landmark, B.T., Bohler, A., Loberg, K., & Wahl, A.K. (2008). Women with newly diagnosed breast cancer and their perceptions of needs in a health-care context. Journal of Clinical Nursing, 17(7B), 192–200.

Lange, M., Rigal, O., Clarisse, B., Giffard, B., Sevin, E., Barillet, M., et al. (2014). Cognitive dysfunctions in elderly cancer patients: A new challenge for oncologists. Cancer Treatment Reviews, 40(6), 810–817.

Lavelle, K., Sowerbutts, A.M., Bundred, N., Pilling, M., Degner, L., Stockton, C., et al. (2014). Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study. British Journal of Cancer, 110(3), 573–583.

Leonard, R., Ballinger, R., Cameron, D., Ellis, P., Fallowfield, L., Gosney, M., et al. (2011). Adjuvant chemotherapy in older women (ACTION) study—What did we learn from the pilot phase? British Journal of Cancer, 105(9), 1260–1266.

Lewis, J.H., Kilgore, M.L., Goldman, D.P., Trimble, E.L., Kaplan, R., Montello, M.J., Housman, M.G., & Escarce, J.J. (2003). Participation of patients 65 years of age or older in cancer clinical trials. Journal of Clinical Oncology, 21(7), 1383–1389.

Lichtman, S.M., Hurria, A., Cirrincione, C.T., Seidman, A.D., Winer, E., Hudis, C., et al. (2012). Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: Combined analysis of CALGB 9342 and 9840. Annals of Oncology, 23(3), 632–638.

Lo, A.X., Donnelly, J.P., McGwin, G., Bittner, V., Ahmed, A., & Brown, C.J. (2015). Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥ 65 years with heart failure. American Journal of Cardiology, 115(6), 797–801.

Luciani, A., Ascione, G., Bertuzzi, C., Marussi, D., Codecà, C., Di Maria, G., Caldiera, S.E., Floriani, I., Zonato, S., Ferrari, D., & Foa, P. (2010). Detecting disabilities in older patients with cancer: Comparison between comprehensive geriatric assessment and vulnerable elders survey-13. Journal of Clinical Oncology, 28(12), 2046–2050.

Malik, M.K., Tartter, P.I., & Belfer, R. (2013). Undertreated breast cancer in the elderly. Journal of Cancer Epidemiology, 2013, 893104.

Mandilaras, V., Wan-Chow-Wah, D., Monette, J., Gaba, F., Monette, M., & Alfonso, L. (2013). The impact of cancer therapy on cognition in the elderly. Frontiers in Pharmacology, 4, 48.

Meldon, S.W., Mion, L.C., Palmer, R.M., Drew, B.L., Connor, J.T., Lewichi, L.J., et al. (2003). A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Academic Emergency Medicine, 10, 224–232.

Miles, D., Baselga, J., Amadori, D., Sunpaweravong, P., Semiglazov, V., Knott, A., et al. (2013). Treatment of older patients with HER2-positive metastatic breast cancer with pertuzumab, trastuzumab, and docetaxel: Subgroup analyses from a randomized, double-blind, placebo-controlled phase III trial (CLEOPATRA). Breast Cancer Research & Treatment, 142(1), 89–99.

Mohile, S.G., Bylow, K., Dale, W., Dignam, J., Martin, K., Petrylak, D.P., et al. (2007). A pilot study of the vulnerable elders survey-13 compared with the Comprehensive Geriatric Assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer, 109, 802–810.

Moons, P., De Ridder, K., Geyskens, K., Sabbe, M., Craes, T., Flamaing, J., et al. (2007). Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: Predictive value of four instruments. European Journal of Emergency Medicine, 14, 315–323.

Morgan, J.L., Reed, M.W., & Wyld, L. (2014). Primary endocrine therapy as a treatment for older women with operable breast cancer—A comparison of randomised controlled trial and cohort study findings. European Journal of Surgical Oncology, 40(6), 676–684.

Muss, H.B., Tu, D., Ingle, J.N., Martino, S., Robert, N.J., Pater, J.L., et al. (2008). Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. Journal of Clinical Oncology, 26(12), 1956–1964.

Muss, H.B., Berry, D.A., Cirrincione, C.T., Theodoulou, M., Mauer, A.M., Kornblith, A.B., et al. (2009). Adjuvant chemotherapy in older women with early-stage breast cancer. New England Journal of Medicine, 360(20), 2055–2065.

Naumann, D., Rusius, V., Margiotta, C., Nevill, A., Carmichael, A., Rea, D., et al. (2013). Factors predicting trastuzumab-related cardiotoxicity in a real-world population of women with HER2+ breast cancer. Anticancer Research, 33(4), 1717–1720.

Overcash, J.A., Beckstead, J., Extermann, M., & Cobb, S. (2005). The abbreviated comprehensive geriatric assessment (aCGA): A retrospective analysis. Critical Reviews in Oncology Hematology, 54, 129–136.

Patnaik, J.L., Byers, T., Diguiseppi, C., Denberg, T.D., & Dabelea, D. (2011). The influence of comorbidities on overall survival among older women diagnosed with breast cancer. Journal of National Cancer Institution, 103(14), 1101–1111.

Peto, R., Davies, C., Godwin, J., Gray, R., Pan, H.C., Clarke, M., et al. (2012). Comparisons between different polychemotherapy regimens for early breast cancer: Meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet, 379(9814), 432–444.

Pinquart, M., & Duberstein, P.R. (2004). Information needs and decision-making processes in older cancer patients. Critical Reviews in Oncology-Hematology, 51(1), 69–80.

Potter, R., Gnant, M., Kwasny, W., Tausch, C., Handl-Zeller, L., Pakisch, B., et al. (2007). Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. International Journal of Radiation Oncology Biology Physics, 68(2), 334–340.

Pritchard, K.I., Burris, H.A. III., Ito, Y., Rugo, H.S., Dakhil, S., Hortobagyi, G.N., et al. (2013). Safety and efficacy of everolimus with exemestane vs. exemestane alone in elderly patients with HER2-negative, hormone receptor-positive breast cancer in BOLERO-2. Clinical Breast Cancer, 13(6), 421–432.e8.

Puts, M.T., Santos, B., Hardt, J., Monette, J., Girre, V., Atenafu, E.G., et al. (2014). An update on a systematic review of the use of geriatric assessment for older adults in oncology. Annals of Oncology, 25(2), 307–315.

Radziewick, R., & Baile, W.F. (2001). Communication skills: Breaking bad news in the clinical setting. Oncology Nursing Forum, 28(6), 951–953.

Randall, T., & Wearn, A.M. (2005). Receiving bad news: Patients with haematological cancer reflect upon their experience. Palliative Medicine, 19(8), 594–601.

Rassin, M., Levy, O., Schwartz, T., & Silner, D. (2006). Caregivers’ role in breaking bad news—Patients, doctors’ and nurses’ points of view. Cancer Nursing, 29(4), 302–308.

Ring, A., Harder, H., Langridge, C., Ballinger, R.S., & Fallowfield, L.J. (2013). Adjuvant chemotherapy in elderly women with breast cancer (AChEW): An observational study identifying MDT perceptions and barriers to decision making. Annals of Oncology, 24(5), 1211–1219.

Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489–495.

Sheppard, V.B., Faul, L.A., Luta, G., Clapp, J.D., Yung, R.L., Wang, J.H., et al. (2014). Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB Protocol 369901. Journal of Clinical Oncology, 32(22), 2318–2327.

Slaets, J.P. (2006). Vulnerability in the elderly: Frailty. Medical Clinics of North America, 90, 593–601.

Smith, B.D., Smith, G.L., Hurria, A., Hortobagyi, G.N., & Buchholz, T.A. (2009). Future of cancer incidence in the United States: Burdens upon an aging, changing nation. Journal of Clinical Oncology, 27(17), 2758–2765.

Smorenburg, C.H., de Groot, S.M., van Leeuwen-Stok, A.E., Hamaker, M.E., Wymenga, A.N., de Graaf, H., et al. (2014). A randomized phase III study comparing pegylated liposomal doxorubicin with capecitabine as first-line chemotherapy in elderly patients with metastatic breast cancer: Results of the OMEGA study of the Dutch Breast Cancer Research Group BOOG. Annals of Oncology, 25(3), 599–605.

Sostelly, A., Henin, E., Chauvenet, L., Hardy-Bessard, A.C., Jestin-Le Tallec, V., Kirsher, S., et al. (2013). Can we predict chemo-induced hematotoxicity in elderly patients treated with pegylated liposomal doxorubicin? Results of a population-based model derived from the DOGMES phase II trial of the GINECO. Journal of Geriatric Oncology, 4(1), 48–57.

Soubeyran, P., Bellera, C.A., Gregoire, F., Blanc, J., Ceccaldi, J., Blanc-Bisson, C., Mertens, C., et al. (2008). Validation of a screening test for elderly patients in oncology. Journal of Clinical Oncology, 26(Suppl. 15S), abstr 20568.

Studenski, S., Perera, S., Patel, K., Rosano, C., Faulkner, K., Inzitari, M., et al. (2011). Gait speed and survival in older adults. Journal of American Medical Association, 305(1), 50–58.

Swanson, J., & Kock, L. (2010). The role of the oncology nurse navigator in distress management of adult patients with cancer: A retrospective study. Oncology Nursing Forum, 37(1), 69–75.

Tang, S. W,. Parker, H., Winterbottom, L., Hassell, K., Ellis, I.O., Morgan, D.A., et al. (2011). Early primary breast cancer in the elderly—pattern of presentation and treatment. Journal of Surgical Oncology, 20(1), 7–12.

Tinterri, C., Gatzemeier, W., Zanini, V., Regolo, L., Pedrazzoli, C., Rondini, E., et al. (2009). Conservative surgery with and without radiotherapy in elderly patients with early-stage breast cancer: A prospective randomised multicentre trial. The Breast, 18(6), 373–377.

Townsley, C., Pond, G.R., Peloza, B., Kok, J., Naidoo, K., Dale, D., et al. (2005). Analysis of treatment practices for elderly cancer patients in Ontario, Canada. Journal of Clinical Oncology 2005, 23(16), 3802–3810.

Wang, F., Liu, J., Liu, L., Wang, F., Ma, Z., Gao, D., et al. (2014). The status and correlates of depression and anxiety among breast-cancer survivors in Eastern China: A population-based, cross-sectional case-control study. BMC Public Health, 14, 326.

Weidung, B., Boström, g., Toots, A., Nordström, P., Carlberg, B., Gustafson, Y., et al. (2015). Blood pressure, gait speed, and mortality in very old individuals: A population-based cohort study. Journal of the American Medical Directors Association, 16(3), 208–214.

Whelan, T.J., Pignol, J.P., Levine, M.N., Julian, J.A., MacKenzie, R., Parpia, S., et al. (2010). Long-term results of hypofractionated radiation therapy for breast cancer. New England Journal of Medicine, 362(6), 513–520.

Wilkes, L., & Jackson, D. (2013). Enabling research cultures in nursing: Insights from a multidisciplinary group of experienced researchers. Nurse Researcher, 20(4), 28–34.

Winzer, K.J., Sauerbrei, W., Braun, M., Liersch, T., Dunst, J., Guski, H., et al. (2010). German Breast Cancer Study Group (GBSG). Radiation therapy and tamoxifen after breast-conserving surgery: Updated results of a 2 x 2 randomised clinical trial in patients with low risk of recurrence. European Journal of Cancer, 46(1), 95–101.

Woods, D., & Trewheellar, K. (1998). Medline and Embase complement each other in literature searches. British Medical Journal, 316(7138), 1166.

Wong, J., D’Alimonte, L., Angus, J., Paszat, L., Metcalfe, K., Whelan, T., et al. (2012). Development of patients’ decision aid for older women with stage I breast cancer considering radiotherapy after lumpectomy. International Journal of Radiation Oncology Biology Physics, 84(1), 30–38.


Refbacks

  • There are currently no refbacks.