Patterns of breast carcinoma treatment in older women - Patient preferenceand clinical and physician influences

BACKGROUND. Older women have high rates of breast carcinoma, and there are substantial variations in the patterns of care for this population group. METHODS. The authors studied 718 breast carcinoma patients age 67 years and older who were diagnosed with localized disease between 1995 and 1997 from 29 hospitals in 5 regions. Data were collected from patients, charts, and surgeons. Logistic regression analysis was used to evaluate determinants of treatment. RESULTS. Women who were: concerned about body image were 1.8 times more lik ely (95% confidence interval [95% CI], 1.1-2.8) to receive breast conservat ion surgery and radiotherapy than women without this preference, controllin g for other factors. In contrast, women who preferred receiving no therapy beyond surgery were 3.9 times more likely (95% CI, 2.9-6.1) to undergo mast ectomy than other women, after considering other factors. Radiotherapy was omitted after breast conservation 3.4 times more often (95% CI, 2.0-5.6) am ong women age 80 years and older than among women ages 67-79 years, control ling for covariates. Black women tended to have radiotherapy omitted after breast conservation surgery 2.0 times more often (95% CI, 0.9-4.4) than whi te women (P = 0.09). Women age 80 years and older also were 70% less likely (odds ratio = 0.3; 95% CI, 0.1-0.8) to receive chemotherapy than women age s 67-79 years, controlling for health, functional status, and other covaria tes. CONCLUSIONS. After considering other factors, patient preferences and age w ere found to be associated with breast carcinoma treatment patterns in olde r women. Further research and training are needed to provide care for the g rowing population of older women that is both clinically appropriate and co nsonant with a woman's preferences. (C) 2000 American Cancer Society.