THE EFFECT OF AGING ON THE UTILIZATION OF CHEMOTHERAPY FOR METASTATICBREAST-CANCER - A POPULATION-BASED STUDY

Older women (i. e., greater than or equal to 65 years of age), receive less adjuvant chemotherapy than younger women, in part because chemot herapy has been less effective in postmenopausal than premenopausal wo men in clinical trials. Metastatic breast cancer, however; does not re spond differently to chemotherapy by age. Therefore, to evaluate furth er the effect of age on chemotherapy utilization, we conducted a popul ation-based study of the treatment of metastatic breast cancer. Patien ts (n = 132) were identified by cross-tabulating death certificates fr ont 1984 to 1991 with breast cancer cases in the Washington County Can cer Registry. Treatment information was obtained from the Tumor Regist ry of the Washington County Hospital and Hospital medical records. For ty patients (74%) <65 years old received chemotherapy compared to 11 ( 42%) 65-74 and 6 (12%) greater than or equal to 75 (p < 0.0001). Adjus ting for other medical conditions and whether or not the patient saw a medical oncologist, there was still a significant effect of age in pa tients greater than or equal to 75 (p < 0.001) and a trend (p = 0.17) for patients 65-74. The different patterns of chemotherapy utilization were not associated with survival differences. Radiation therapy was also utilized significantly less frequently in older than younger pati ents, but the age effect was not as pronounced as with chemotherapy. T here was no age effect on the utilization of hormonal therapy. Less fr equent utilization of chemotherapy in older patients is probably cause d by a combination of patient and physician factors and may result in less effective palliation for older patients.