Breast Cancer Treatment of Older Women in Integrated Health Care Settings

Author:

Enger Shelley M.1,Thwin Soe Soe1,Buist Diana S.M.1,Field Terry1,Frost Floyd1,Geiger Ann M.1,Lash Timothy L.1,Prout Marianne1,Yood Marianne Ulcickas1,Wei Feifei1,Silliman Rebecca A.1

Affiliation:

1. From the Department of Research and Evaluation, Kaiser Permanente Medical Care Program, Pasadena, CA; Boston University Medical Center; Department of Epidemiology, Boston University School of Public Health, Boston; Meyers Primary Care Institute of Fallon Community Health Plan/Fallon Foundation/University of Massachusetts Medical School, Worcester, MA; Center for Health Studies, Group Health Cooperative, Seattle, WA; Lovelace Respiratory Research Institute, Albuquerque, NM; Division of Public Health...

Abstract

Purpose A substantial literature describes age-dependent variations in breast cancer treatment, showing that older women are less likely to receive standard treatment than younger women. We sought to identify patient and tumor characteristics associated with the nonreceipt of standard primary tumor and systemic adjuvant therapies. Patients and Methods We studied 1,859 women age 65 years or older with stage I and II breast cancer diagnosed between 1990 and 1994 who were cared for in six geographically dispersed community-based health care systems. We collected demographic, tumor, treatment, and comorbidity data from electronic data sources, including cancer registry, administrative, and clinical databases, and from subjects' medical records. Results Women 75 years of age or older and women with higher comorbidity indices were more likely to receive nonstandard primary tumor therapy, to not receive axillary lymph node dissection, and to not receive radiation therapy after breast-conserving surgery (BCS). Asian women were less likely to receive BCS, and African American women were less likely to be prescribed tamoxifen. Although nonreceipt of most therapies was associated with a lower baseline risk of recurrence, an important minority of high-risk women (16% to 30%) did not receive guideline therapies. Conclusion Age is an independent risk factor for nonreceipt of effective cancer therapies, even when comorbidity and risk of recurrence are taken into account. Information regarding treatment effectiveness in this age group and tools that allow physicians and patients to estimate the benefits versus the risks of therapies, taking into account age and comorbidity burden, are critically needed.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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