title: Discrepancy between consensus recommendations and actual community use of adjuvant chemotherapy in women with breast cancer.
abstract: BACKGROUND
  Although the efficacy of adjuvant chemotherapy in prolonging survival for women with breast cancer has been well documented, limited population-based information is available on the actual use of chemotherapy.
  
  
  OBJECTIVE
  To examine the relationship between age and chemotherapy use.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  New Mexico.
  
  
  METHODS
  5101 women 20 years of age or older receiving a diagnosis of stage I, stage II, or stage IIIA breast cancer from 1991 through 1997.
  
  
  METHODS
  Pattern of chemotherapy use by age; logistic regression analysis to generate the odds and probabilities of receiving chemotherapy; and sensitivity analysis to estimate potential effects of unmeasured confounders.
  
  
  RESULTS
  Overall, 29% of women received chemotherapy. The rate of chemotherapy use for women with stage I, stage II, or stage IIIA breast cancer was 11%, 47%, and 68%, respectively. Across all tumor stages, the use of chemotherapy decreased substantially with increasing age (P < 0.001). Overall, 66% of women younger than 45 years of age received chemotherapy compared with 44% of women between 50 and 54 years of age, 31% of women between 55 and 59 years of age, and 18% of women between 60 and 64 years of age. The decreasing pattern of chemotherapy use with age continued after adjustment for prognostic factors and was relatively insensitive to changes in unmeasured factors.
  
  
  CONCLUSIONS
  There is considerable discrepancy between the 1990 National Institutes of Health Consensus Conference recommendations for chemotherapy administration in women with breast cancer and the actual use of chemotherapy in the community. The decrease in use with age may relate to the decreasing efficacy of chemotherapy with age, as reported in clinical trials. Outcomes studies should address whether the recommendations are overly aggressive or whether practicing oncologists are too conservative in their use of chemotherapy.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA. xdu@utmb.edu
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
authors.forename: Charles R
authors.initials: CR
authors.lastname: Key
authors.forename: Cynthia
authors.initials: C
authors.lastname: Osborne
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D015999:Multivariate Analysis; D009316:National Institutes of Health (U.S.); D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D000970:Antineoplastic Agents