Adjuvant tamoxifen prescription in women 65 years and older with primary breast cancer.
OBJECTIVE
We examined patterns of adjuvant tamoxifen discussion and prescription among breast cancer patients age 65 years and older.


METHODS
We selected from women diagnosed with primary breast cancer those with (1) stage I (tumor diameter > or = 1 cm), stage II, or stage IIIa disease; (2) age 65 years or older on the date of diagnosis; and (3) permission from the attending physician to contact. Data were collected from consenting patients' medical records, telephone interviews with patients, and mailed questionnaires completed by their physicians.


RESULTS
We obtained medical record and interview data for 698 patients. The oldest patients (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.23 to 0.87 for those aged 80+ relative to those aged 65 to 69 years old), those with more comorbid conditions (each additional comorbid condition reduced the odds of discussion by 0.84; 95% CI, 0.73 to 0.96), and those who were estrogen receptor-negative (OR, 0.56; 95% CI, 0.32 to 0.99) were less likely to report discussion of tamoxifen therapy with a physician. Older patients (OR, 2.17; 95% CI, 1.18 to 4.01 for 70- to 79-year-olds relative to 65- to 69-year-olds; OR, 2.44; 95% CI, 1.11 to 5.34 for those aged 80+ relative to those aged 65 to 69 years old), those who reported a greater influence of information about tamoxifen on decision-making (an increase in 1 SD increased the odds by 7.43; 95% CI, 4.36 to 12.65), and those whose physicians believed that the benefits of tamoxifen outweighed its risks (an increase in 1 SD increased the odds by 1.87; 95% CI, 1.34 to 2.62) were more likely to be prescribed tamoxifen.


CONCLUSIONS
These findings highlight the key role of communication in the care of older women with breast cancer and its ultimate influence on the receipt of therapy.
Silliman
Rebecca A
RA
Department of Medicine, Boston University School of Medicine, MA, USA. rsillima@bu.edu
Guadagnoli
Edward
E
Rakowski
William
W
Landrum
Mary Beth
MB
Lash
Timothy L
TL
Wolf
Robert
R
Fink
Aliza
A
Ganz
Patricia A
PA
Gurwitz
Jerry
J
Borbas
Catherine
C
Mor
Vincent
V
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D016015:Logistic Models; D009367:Neoplasm Staging; D018579:Patient Selection; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011960:Receptors, Estrogen / Q000378:metabolism; D013629:Tamoxifen / Q000627:therapeutic use*; D014481:United States
D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D011960:Receptors, Estrogen; D013629:Tamoxifen