Age-related patterns of care: Evidence against ageism in the treatment of early-stage breast cancer
Age-related patterns of care: Evidence against ageism in the treatment of early-stage breast cancer
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DOI：
10.1200/jco.1997.15.6.2338
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发表时间：
1997-06-01
影响因子：
45.3
通讯作者：
Soumerai, SB
中科院分区：
文献类型：
--
作者：
Guadagnoli, E;Shapiro, C;Soumerai, SB
目的：探讨绝经后早期乳腺癌患者的辅助系统治疗是否受年龄的影响。方法：对明尼苏达州30家医院746例确诊为早期乳腺癌的绝经后女性患者进行了一项回顾性队列研究，分析了激素治疗、化疗以及激素治疗和化疗与年龄的关系。结果：在淋巴结阴性的女性中，62%接受了某种形式的辅助药物治疗。对于这些女性来说，接受激素治疗或同时接受激素治疗和化疗的可能性没有随着患者年龄的增长而变化，接受化疗的可能性随着年龄的增加而下降。在淋巴结阳性的女性中，92%的人接受了某种形式的放射治疗，对于这些女性来说，接受激素治疗的可能性随着年龄的增加而增加，接受化疗的可能性随着年龄的增加而下降，同时接受激素治疗和化疗的可能性也是如此。结论：所观察到的年龄与辅助系统治疗的使用之间的联系似乎总体上反映了有关治疗效果的现有信息，并未表明早期乳腺癌的老年女性使用的可能性不足。辅助治疗的使用取决于预测转移风险增加或治疗反应增加的临床因素，而不是其他社会人口学因素。我们的结果还表明，与年长女性相比，淋巴结阳性的年轻绝经后女性可能因化疗取代激素治疗而未得到他莫昔芬的治疗。(C)1997年，由美国临床肿瘤学会主办。
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 adiuvant 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. (C) 1997 by American Society of Clinical Oncology.