Breast Cancer Treatment Effectiveness in Older Women

描述（由研究者提供）：2001年估计有192，200名妇女被诊断患有乳腺癌，其中一半以上的人年龄在60岁或以上。 令人关切的是，虽然70岁以下妇女的乳腺癌死亡率有所下降，但70岁或70岁以上妇女的乳腺癌死亡率要么保持稳定（70-79奥尔兹），要么正在上升（80奥尔兹以上）。 对此的一种解释是，老年妇女比年轻妇女更经常接受低于标准的治疗。 迄今为止，疗效和有效性数据均未证明这种护理模式的合理性。 利用健康维护组织（HMO）癌症研究网络的优势，我们建议对1990年至1994年期间新诊断为早期乳腺癌（I-II期）的一组老年妇女（>65岁）进行历史队列研究。 具体而言，我们将（1）比较标准原发性肿瘤治疗的有效性（保乳手术、腋窝淋巴结清扫术和放射治疗或改良根治性乳房切除术）与标准治疗以外的其他治疗在预防乳腺癌复发和死亡方面的比较，调整了合并症、肿瘤特征、地理部位和人口统计学特征;（2）确定增加全身辅助治疗的程度（化学疗法、激素疗法或化学疗法和激素疗法的组合）改变标准和非标准原发性肿瘤疗法在预防乳腺癌复发和死亡率方面的有效性;（3）描述乳腺癌复发监测试验的模式，并确定监测试验与降低乳腺癌特异性死亡率相关的程度;（4）确定HMO环境中新诊断早期疾病的老年妇女接受标准原发性肿瘤治疗和全身辅助治疗的相关提供者、肿瘤和患者特征。 来自美国各地的六个地点将共同确定和跟踪2180名妇女十年。 电子和病历数据源将用于收集信息，使我们能够描述治疗、肿瘤和患者特征对乳腺癌复发和死亡率的单独和联合影响。 这项研究的结果将为临床实践提供信息，特别是不太可能参加临床试验的患有合并症的老年妇女的护理。

DESCRIPTION (provided by investigator): An estimated 192,200 women were diagnosed with breast cancer in 2001, more than half of whom were 60 years of age or older. Of concern is that while breast cancer-specific mortality rates have declined among women less than 70 years old, they are either stable (70-79 year olds) or are increasing (80+ year olds) among those 70 years or older. One explanation for this is that older women receive less than standard therapy more frequently than younger women. Neither efficacy nor effectiveness data to date justify this pattern of care. Taking advantage of the Health Maintenance Organization (HMO) Cancer Research Network, we propose to conduct a historical cohort study of an unselected group of older women (>65 years of age) newly diagnosed with early stage breast cancer (stages I-II) between 1990 and 1994. Specifically, we will (1) Compare the effectiveness of standard primary tumor therapy (breast conserving surgery, axillary dissection, and radiation therapy or modified radical mastectomy) versus other than standard therapy in preventing breast cancer recurrences and mortality, adjusting for co-morbidity, tumor characteristics, geographic site, and demographic characteristics; (2) Determine the extent to which the addition of systemic adjuvant therapy (chemotherapy, hormonal therapy, or the combination of chemotherapy and hormonal therapy) modifies the effectiveness of standard and other than standard primary tumor therapy in preventing breast cancer recurrences and mortality; (3) Describe patterns of surveillance testing for breast cancer recurrence and determine the extent to which surveillance testing is associated with a reduction in breast cancer-specific mortality; and (4) Identify provider, tumor, and patient characteristics associated with the receipt of standard primary tumor therapy and systemic adjuvant therapy in older women with newly diagnosed early stage disease in the HMO setting. Six sites from throughout the United States will together identify and follow 2180 women for ten years. Both electronic and medical record data sources will be used to collect information that will allow us to characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer recurrence and mortality. Findings from this study will inform clinical practice, particularly the care of older women with co-morbidities who are unlikely to participate in clinical trials.