The Effect of Age on the Care of Women With Breast Cancer in Community Hospitals

Chu, Joseph; Diehr, Paula; Feigl, Polly; Glaefke, Gwen; Begg, Colin B.; Glicksman, Arvin S.; Ford, Leslie

doi:10.1093/geronj/42.2.185

Cited by 131 publications

(69 citation statements)

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“…There are several reasons for this widespread prevalence of unsupported beliefs about elderly cancer patients: (i) a tiny minority of 1% of all cancer patients is treated in clinical trials worldwide [43], (ii) patients 165-70 years are usually systematically excluded from clinical trials [10][11][12]44], (iii) even trials especially designed for the study of (lymphatic) neoplasias in the elderly exclude on conceptual grounds patients suffering from age-specific comorbidity [36,45,46]. Thus, most available information is restricted to people with atypical young biological age [10], and (iv) outside clinical trials and with increasing age an increasing proportion of patients receives protocols omitting standard substances [47,48] or is even excluded from any treatment whatsoever [49]. These observations hold true even if patients of different age categories are well balanced for comorbidities [47,50].…”

Section: Treatment Of Elderly Lymphoma Patientsgeneral Aspectsmentioning

confidence: 99%

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

Greil

1998

Oncology

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Lymphomas belong to the class of malignant diseases with the fastest increasing incidence. High-grade non-Hodgkin’s lymphomas (NHL) display a peak of incidence in the age group above 65. In the last few years, age has been recognized as a major risk factor for overall survival of high-grade NHL patients, and numerous attempts have been made to analyze the contribution of factors to the age-related worsening of prognosis in this disease, e.g. the biology of the disease on the one hand, and age-specific comorbidity or degree of cytotoxicity, reluctance in diagnosis and treatment and socioeconomic factors on the other. Furthermore, age-adapted treatment protocols have been designed and tested for their practicability and efficacy in the elderly. Very recently, large randomized prospective clinical trials have been carried out which support the idea that treatment with a curative intent is warranted even in the very elderly and that a successful attempt to cure requires the use of full-dose anthracycline-containing regimens closely similar to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). In addition, progress has been made in systematically defining maximally tolerated doses of the cytotoxic drugs and in specifically testing anthracyclines with reduced cardiotoxicity with an efficacy similar to that of doxorubicin, and further in investigating the advantage of applying hematopoietic growth factors and/or cardioprotective drugs in this older population. In limited stages of disease, three cycles of CHOP chemotherapy followed by involved field irradiation may be superior to radiotherapy and prolonged chemotherapy and may produce highly satisfying cure rates.

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Section: Treatment Of Elderly Lymphoma Patientsgeneral Aspectsmentioning

confidence: 99%

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

Greil

1998

Oncology

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“…Chu and colleagues studied the care of 1922 women at 17 hospitals in the NCI Community Hospital Oncology Program during 1982 and 1983 [30]. They evaluated rates of referral to a medical oncologist, which is generally a prelude to systemic therapy, and noted no significant difference by age among women with distant disease.…”

Section: Agementioning

confidence: 99%

Variations in breast cancer treatment by patient and provider characteristics

Ayanian¹,

Guadagnoli

1996

Breast Cancer Res Tr

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Guidelines for the optimal treatment of breast cancer have been publicized over the past 15 years, yet clinical practices continue to vary substantially in the United States. This article reviews the literature on variations in local and systemic treatment of breast cancer by patient and provider characteristics. Studies of local therapy have consistently demonstrated that older women are less likely than younger women to receive radiation therapy after breast-conserving surgery. Some studies have noted that black women are less likely than white women to receive breast-conserving surgery and less likely to receive radiation therapy after breast-conserving surgery. Rates of breast-conserving surgery vary three-fold among geographic regions and between teaching and non-teaching hospitals. Patients at smaller hospitals appear less likely to receive indicated radiation therapy. Patterns of systemic therapy have not been well described. Women over age 75 may not be receiving adequate hormonal therapy, but recent data are not available. Limited data suggest that rates of systemic therapy do not vary substantially by race or Hispanic ethnicity, but women without health insurance may not be receiving appropriate chemotherapy. Studies relating hospital and physician characteristics to the use of systemic therapy are sparse and inconclusive. In order to increase the proportion of women who receive optimal treatment for breast cancer and ensure greater equity, a more sophisticated understanding of variations in clinical practice will be required. These variations may arise from insufficient knowledge of or disagreement with guidelines among physicians, inadequate communication between physicians and patients, and individual preferences or clinical attributes of patients. Future studies will need to explore the dialogue between women and their physicians that leads to decisions about treatment of breast cancer.

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“…However, rates failed to decline for older women, and older black women actually experienced an increase in mortality rates. [1][2][3] The observed excess mortality rates among older black women may be due to the interaction of several complex phenomena, including poverty, 4,5 culturally based attitudes, 6,7 bias in treatment, 5,8,9 stage at presentation, 10 -12 access to, or adequacy of treatment, 10,[13][14][15][16][17] tumor biology, 18 -23 and comorbid medical conditions. 24 In this study, data from a random sample of black and white Medicare beneficiaries treated in fee-forservice settings for local breast carcinoma are used to describe the associations between race and local treatment.…”

mentioning

confidence: 99%

Variations in breast carcinoma treatment in older medicare beneficiaries

Mandelblatt

Kerner

Hadley

et al. 2002

Cancer

134

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BACKGROUNDTo evaluate associations between race and breast carcinoma treatment.METHODSData from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3–4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources.RESULTSSixty‐seven percent of women received a mastectomy and 33% received breast‐conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01–2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race‐stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25–5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06).CONCLUSIONSOlder black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within‐stage race mortality disparities. Cancer 2002;95:1401–14. © 2002 American Cancer Society.DOI 10.1002/cncr.10825

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The Effect of Age on the Care of Women With Breast Cancer in Community Hospitals

Cited by 131 publications

References 0 publications

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

Prognosis and Management Strategies of Lymphatic Neoplasias in the Elderly

Variations in breast cancer treatment by patient and provider characteristics

Variations in breast carcinoma treatment in older medicare beneficiaries

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