title: Causes for the undertreatment of elderly breast cancer patients: tailoring treatments to individual patients.
abstract: BACKGROUND
  Ageism has been suggested as a cause for the undertreatment of elderly breast cancer patients. The purpose of this study was to determine the rate and causes of elderly patients not receiving standard therapy.
  
  
  METHODS
  A random sample of 500 patients was reviewed for age, cancer stage, surgical, radiation, cytotoxic or hormonal chemotherapy, number and type of comorbidities, type of therapeutic deficiencies, and their causes.
  
  
  RESULTS
  The average age was 59.9+/-13.6 years. Of the patients less than 65 years old, 6.0% did not receive standard treatment, compared with 22.2% of patients 65 years or older. Treatment omitted in the less than 65-year-old group: 16.7%, no tumor extirpation; 38.9%, no axillary dissection; 33.3%, no radiation therapy; and 33.3% no chemotherapy. Treatment omitted in the 65-year and older group: 11.4%, no tumor extirpation; 39.1%, no axillary dissection; 47.7%, no radiation therapy; and 18.2%, no chemotherapy. Causes in the less than 65-year-old group were: prohibitive associated medical conditions, 27.8%; favorable primary tumor pathology, 16.7%; and patient treatment refusal, 55.6%. Causes in the 65-year and older group were: prohibitive associated medical conditions, 40.9%; favorable tumor pathology, 13.6%; patient treatment refusal, 31.8%; and unexplainable, 13.6%. The median number of concomitant medical conditions in patients receiving standard therapy was one compared with three in the undertreated patients from prohibitive associated medical conditions or unexplained causes.
  
  
  CONCLUSIONS
  Population-based studies of breast cancer treatment do not adequately assess the complex decision making associated with breast cancer in the elderly. Patients do not receive standard care for specific reasons.
authors.affiliation: Department of Surgery, Henry Ford Hospital and the Josephine Ford Cancer Center, Detroit, MI 48202-2689, USA.
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Molly
authors.initials: M
authors.lastname: Gabel
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Walker
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Doyle
authors.forename: Robert M
authors.initials: RM
authors.lastname: O'Bryan
authors.forename: Wanda
authors.initials: W
authors.lastname: Szymanski
authors.forename: John J
authors.initials: JJ
authors.lastname: Ferrara
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lewis
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D016312:Treatment Refusal