Breast cancer treatment of older women in integrated health care settings.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Enger
Shelley M
SM
Department of Research and Evaluation, Kaiser Permanente Medical Care Program, Pasadena, CA, USA.
Thwin
Soe Soe
SS
Buist
Diana S M
DS
Field
Terry
T
Frost
Floyd
F
Geiger
Ann M
AM
Lash
Timothy L
TL
Prout
Marianne
M
Yood
Marianne Ulcickas
MU
Wei
Feifei
F
Silliman
Rebecca A
RA
D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001213:Asian / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D008499:Medical Records; D016017:Odds Ratio; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013629:Tamoxifen / Q000008:administration & dosage; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen