Journal of Clinical Oncology, Vol 15, 2338-2344, Copyright © 1997 by American Society of Clinical Oncology
Age-related patterns of care: evidence against ageism in the treatment of early-stage breast cancer
E Guadagnoli, C Shapiro, JH Gurwitz, RA Silliman, JC Weeks, C Borbas and SB Soumerai
Health Care Policy, Department of Medicine, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA 02115, USA. guadagnoli@chcp.med.harvard.edu
PURPOSE: To assess whether the use of adjuvant systemic therapy in
postmenopausal women with early-stage breast cancer is influenced by
patient age. METHODS: A retrospective cohort study based on data collected
from medical records and from patients and their surgeons was performed
among 746 postmenopausal patients diagnosed with early-stage breast cancer
at 30 hospitals located throughout Minnesota. The adjusted odds of
receiving hormonal therapy, chemotherapy, and both hormonal therapy and
chemotherapy as a function of age was determined. RESULTS: Among women with
negative lymph nodes, 62% received some form of adjuvant drug therapy. For
these women, the likelihood of receiving hormonal therapy or both hormonal
therapy and chemotherapy did not vary with patient age and the likelihood
of receiving chemotherapy declined with age. Among women with positive
lymph nodes, 92% received some form of adjuvant therapy. For these women,
the likelihood of receiving hormonal therapy increased with age and the
likelihood of receiving chemotherapy declined with age, as did the
likelihood of receiving both hormonal therapy and chemotherapy. CONCLUSION:
The observed associations between age and the use of adjuvant systemic
therapy appear to reflect, in general, available information about
treatment efficacy and do not suggest underuse among elderly women with
early- stage breast cancer. The use of adjuvant therapy depends on clinical
factors that predict the increased risk of metastases or the increased
likelihood of response to treatment, rather than other sociodemographic
factors. Our results also suggest that younger postmenopausal women with
positive lymph nodes compared with older women may be undertreated with
respect to tamoxifen because of the substitution of chemotherapy for
hormonal therapy.
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