THE IMPACT OF AGE, MARITAL-STATUS, AND PHYSICIAN-PATIENT INTERACTIONSON THE CARE OF OLDER WOMEN WITH BREAST-CARCINOMA

Understanding why older women with breast carcinoma do not receive def initive treatment is critical if disparities in mortality between youn ger and older women are to be reduced. With this in mind, the authors studied 302 women age greater than or equal to 55 years with early sta ge breast carcinoma. Data were collected from surgical records and in telephone interviews with the women. The main outcome was receipt of d efinitive primary tumor therapy, defined either as modified radical ma stectomy or as breast-conserving surgery with axillary dissection foll owed by radiation therapy. The majority (56%) of the women underwent b reast-conserving surgery and axillary dissection followed by radiation therapy. After statistical control for four variables (comorbidity, p hysical function, tumor size, and lymph node status), patients' ages, marital status, and the number of times breast carcinoma specialists d iscussed treatment options were significantly associated with the rece ipt of definitive primary tumor therapy. The authors concluded that wh en older women have been newly diagnosed with breast carcinoma and the re is clinical uncertainty as to the most appropriate therapies, patie nts may be better served if they are offered choices from among defini tive therapies. In discussing therapies with them, physicians must be sensitive to their fears and concerns about the monetary costs and fun ctional consequences of treatment in relation to the expected benefits . (C) 1997 American Cancer Society.