NHS services are well organised to deliver breast cancer care in line with national clinical guidelines, according to a new audit.
However, services require improvements to meet the individual needs of older patients. Recommendations from the report include:
- Breast cancer units should review whether patients and carers feel they are involved adequately in decision making.
- Local protocols should be developed and implemented (1) to improve the formal assessment of older patients’ health and (2) to improve the identification of patients who could benefit from access to teams caring for the older person.
- Clinicians and hospital managers should review their hospital length of stay figures.
- Professional stakeholders such as Royal Colleges and specialist societies should define the contributions of specialists such as the team caring for the older person, specialist nurses, anaesthetists and palliative care, in the delivery of breast cancer services for older patients.
The National Audit of Breast Cancer in Older Patients, which has been published for the first time by the Royal College of Surgeons and the Association of Breast Surgery, found that nationally, around 90% of women aged 50-69 years diagnosed with breast cancer had surgery. Among women aged 70 years or older, the proportion of women who had surgery fell steadily with increasing age, and was approximately 15% for women aged 90 years and over. Surgery to remove the tumour is the primary treatment for breast cancer but other therapies may be preferable for older women if they suffer from existing conditions like heart disease or are too frail.
Breast cancer is the most common female cancer in the UK. There are around 45,000 new cases of breast cancer diagnosed in women each year in England and Wales, with one third occurring in women aged over 70 years.
Prof Kieran Horgan, the Audit surgical lead, said: “Breast cancer can have a dramatic impact on patients and families. While care by NHS services in England and Wales is consistently rated highly by breast cancer patients in general, the first results from this audit have highlighted some variation in the care older patients receive around the country. One of the reasons for this is that, while there is good evidence for the treatment of breast cancer, there is less advice on how this treatment should be optimally tailored for older women.”
Prof David Dodwell, the Audit oncological lead, said: “This national audit is the first to focus on the care of older women in breast cancer. This is important because these women often have different needs compared to younger patients as they may be less suitable for surgery and chemotherapy. By starting this audit, and providing information back to breast cancer services, we can start to ensure care is delivered more consistently to older women across the country.”
The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme, and is being carried out by the Royal College of Surgeons of England and the Association of Breast Surgery. The audit, which is the first of its kind, will evaluate the quality of care provided to women aged 70 years or older by breast cancer services in England and Wales. It examines the care pathway of breast cancer patients from their initial diagnosis to the end of primary treatment.
