title: Referral, receipt, and completion of chemotherapy in patients with early-stage breast cancer older than 65 years and at high risk of breast cancer recurrence.
abstract: OBJECTIVE
  Some women with early-stage breast cancer are at higher risk of recurrence and can benefit from chemotherapy. We describe patterns of referral, receipt, and completion of chemotherapy among older women at high risk of recurrence.
  
  
  METHODS
  A total of 2,124 women age 65 years or older who were diagnosed with early-stage breast cancer between 1990 and 1994 and 1996 to 1999 were included; 1,090 of these were at high risk of recurrence. We reviewed medical records to categorize chemotherapy outcomes as follows: did not discuss or were not referred to a medical oncologist (n = 133); discussed and/or referred to a medical oncologist but received no chemotherapy (n = 742); received an incomplete chemotherapy course (n = 29), or received a completed chemotherapy course (n = 186).
  
  
  RESULTS
  Overall, 19.7% of high-risk women received any chemotherapy, and 86.5% of these women completed their chemotherapy courses. Just greater than 10% of high-risk women did not have a discussion about chemotherapy as part of breast cancer treatment documented in the medical record; these women also received fewer diagnostic assessments of their initial tumors.
  
  
  CONCLUSIONS
  Individuals who receive chemotherapy for early-stage breast cancer are a select subgroup of patients at high risk of recurrence. This study identifies characteristics of women who were referred for and who received chemotherapy, and this study plays an important role in understanding generalizability of studies that examine chemotherapy treatment effectiveness. Outcomes after breast cancer could continue to be improved with increased receipt of chemotherapy among older women at high risk of breast cancer recurrence.
authors.affiliation: Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. buist.d@ghc.org
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.forename: Marianne
authors.initials: M
authors.lastname: Prout
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Jaclyn L F
authors.initials: JL
authors.lastname: Bosco
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Thwin
authors.forename: Heather Taffet
authors.initials: HT
authors.lastname: Gold
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Feifei
authors.initials: F
authors.lastname: Wei
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D012017:Referral and Consultation
chemical_list: D000970:Antineoplastic Agents
references.citation: Consens Statement. 1990 Jun 18-21;8(6):1-19
references.pmid: 2247093
references.citation: J Clin Oncol. 2007 May 10;25(14):1858-69
references.pmid: 17488984
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Ann Oncol. 1992 Dec;3(10):801-7
references.pmid: 1286043
references.citation: N Engl J Med. 2007 Nov 29;357(22):2219-21
references.pmid: 18046025
references.citation: J Clin Oncol. 2006 Feb 20;24(6):872-7
references.pmid: 16484696
references.citation: JAMA. 2004 Jun 9;291(22):2720-6
references.pmid: 15187053
references.citation: J Natl Cancer Inst. 1995 Oct 4;87(19):1441-5
references.pmid: 7674331
references.citation: Eur J Cancer. 1995 Oct;31A(11):1754-9
references.pmid: 8541094
references.citation: J Natl Cancer Inst Monogr. 2005;(35):3-11
references.pmid: 16287880
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Sep;60(9):1137-44
references.pmid: 16183952
references.citation: J Clin Oncol. 2006 Jun 20;24(18):2757-64
references.pmid: 16782916
references.citation: Hepatology. 2006 Nov;44(5):1075-82
references.pmid: 17058242
references.citation: JAMA. 1991 Jan 16;265(3):391-5
references.pmid: 1984541
references.citation: Cancer. 2007 Mar 1;109(5):966-74
references.pmid: 17243096
references.citation: J Clin Oncol. 2006 Sep 20;24(27):4377-83
references.pmid: 16983106
references.citation: BMC Med Res Methodol. 2007 Jun 18;7:23
references.pmid: 17577410
references.citation: J Am Coll Surg. 2008 Jan;206(1):66-75
references.pmid: 18155570
references.citation: J Clin Oncol. 2006 Jun 20;24(18):2697-9
references.pmid: 16782908
references.citation: Ann Surg Oncol. 2007 Dec;14(12):3321-7
references.pmid: 17899285
references.citation: J Clin Oncol. 2006 Jun 20;24(18):2750-6
references.pmid: 16782915