Breast Cancer Treatment among Older Women in Integrated Health Care Settings
Older women are less likely to receive standard primary tumor and systemic adjuvant therapies compared with younger women.
Purpose: To identify patient and tumor characteristics associated with the non-receipt of standard primary tumor and systemic adjuvant therapies among older women with breast cancer. Methods: A retrospective cohort study of 1,859 women aged 65 years or older with stage I and II breast cancer diagnosed between 1990 and 1994, drawn from six geographically dispersed community-based health systems. Data were extracted from cancer registries, administrative and clinical databases, and medical records. Results: Women 75 years or older and those with higher comorbidity indices were more likely to receive non-standard primary tumor therapy, to not receive axillary lymph node dissection, and to not receive radiation therapy after breast-conserving surgery. Asian women were less likely to undergo breast-conserving surgery, and African American women were less likely to be prescribed tamoxifen. Although most non-receipt of treatments was associated with lower baseline recurrence risk, a minority (16–30%) of high-risk women did not receive guideline-recommended therapies. Conclusions: Age is an independent risk factor for non-receipt of effective cancer therapies. Tools to estimate benefits versus risks of therapies accounting for age and comorbidity are critically needed.
An older age group underuses guideline-standard breast cancer therapies, potentially leading to suboptimal outcomes and reduced survival benefits for a population with high disease burden. Identifying factors driving this underuse guides interventions to improve care equity.
Bizonyítékszint: Korai humán adat. Kis vagy feltáró emberi adat.
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