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.
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.
Buist
Diana S M
DS
Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. buist.d@ghc.org
Chubak
Jessica
J
Prout
Marianne
M
Yood
Marianne Ulcickas
MU
Bosco
Jaclyn L F
JL
Thwin
Soe Soe
SS
Gold
Heather Taffet
HT
Owusu
Cynthia
C
Field
Terry S
TS
Quinn
Virginia P
VP
Wei
Feifei
F
Silliman
Rebecca A
RA
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
D000970:Antineoplastic Agents
Consens Statement. 1990 Jun 18-21;8(6):1-19
2247093
J Clin Oncol. 2007 May 10;25(14):1858-69
17488984
J Chronic Dis. 1987;40(5):373-83
3558716
Ann Oncol. 1992 Dec;3(10):801-7
1286043
N Engl J Med. 2007 Nov 29;357(22):2219-21
18046025
J Clin Oncol. 2006 Feb 20;24(6):872-7
16484696
JAMA. 2004 Jun 9;291(22):2720-6
15187053
J Natl Cancer Inst. 1995 Oct 4;87(19):1441-5
7674331
Eur J Cancer. 1995 Oct;31A(11):1754-9
8541094
J Natl Cancer Inst Monogr. 2005;(35):3-11
16287880
J Gerontol A Biol Sci Med Sci. 2005 Sep;60(9):1137-44
16183952
J Clin Oncol. 2006 Jun 20;24(18):2757-64
16782916
Hepatology. 2006 Nov;44(5):1075-82
17058242
JAMA. 1991 Jan 16;265(3):391-5
1984541
Cancer. 2007 Mar 1;109(5):966-74
17243096
J Clin Oncol. 2006 Sep 20;24(27):4377-83
16983106
BMC Med Res Methodol. 2007 Jun 18;7:23
17577410
J Am Coll Surg. 2008 Jan;206(1):66-75
18155570
J Clin Oncol. 2006 Jun 20;24(18):2697-9
16782908
Ann Surg Oncol. 2007 Dec;14(12):3321-7
17899285
J Clin Oncol. 2006 Jun 20;24(18):2750-6
16782915