Breast Cancer Treatment Effectiveness in Older Women

描述(由调查人员提供)：2001年估计有192,200名妇女被诊断患有乳腺癌，其中超过一半的人年龄在60岁或以上。令人担忧的是，尽管70岁以下女性的乳腺癌死亡率有所下降，但在70岁或70岁以上的女性中，乳腺癌死亡率要么保持稳定(70-79岁)，要么在上升(80岁以上)。对此的一种解释是，老年女性接受非标准治疗的频率比年轻女性更高。到目前为止，无论是疗效还是有效性数据都不能证明这种护理模式的合理性。利用卫生维护组织(HMO)癌症研究网络的优势，我们建议对1990至1994年间新诊断为早期乳腺癌(I-II期)的未选定的老年妇女(65岁)进行一项历史队列研究。具体地说，我们将(1)比较标准原发肿瘤治疗(保乳手术、腋窝清扫和放射治疗或改良的乳腺癌根治术)与非标准治疗在预防乳腺癌复发和死亡率方面的有效性，并调整发病率、肿瘤特征、地理位置和人口统计特征；(2)确定增加全身辅助治疗(化疗、激素治疗或化疗和激素治疗的组合)在多大程度上改变标准和非标准原发肿瘤治疗在预防乳腺癌复发和死亡方面的有效性；(3)描述乳腺癌复发监测测试的模式，并确定监测测试与降低乳腺癌相关死亡率的程度；和(4)确定与接受标准初级肿瘤治疗和系统辅助治疗相关的提供者、肿瘤和患者特征，这些老年妇女在HMO环境中新诊断为早期疾病。来自全美的六个网站将在十年内共同识别和跟踪2180名女性。电子和病历数据来源将用于收集信息，使我们能够确定治疗、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参考，特别是对不太可能参与临床试验的合并疾病的老年妇女的护理。

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.