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Press Release Date: July 31, 2000
Women over age 80 with early stage breast cancer frequently do not get a full range of treatments, even after considering their health and treatment preferences, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ). This study, conducted by the Lombardi Cancer Center, Georgetown University Medical Center, Washington, D.C., and researchers at 29 hospitals across the country, is being published Tuesday, August 1, 2000, in the Cancer journal.
Specifically, women 80 years and older were less likely to be referred to a radiation oncologist, and after breast conserving therapy, they were more than three times more likely not to receive radiation therapy. The risk of cancer recurrence approaches 40 percent within 10 years when radiation is not given after a lumpectomy, well within the life expectancy for most older women.
The study also found that older black women seem to be less likely than older white women to receive radiation after lumpectomy. Researchers note that while the sample of black women was fairly small, this finding of differences in breast cancer treatment patterns by race is consistent with other research.
Researchers point out that older women's preferences, such as maintaining body image, were consistently important in determining treatment. They also conclude that when patient-physician communication focuses on patient concerns, it helps overall in patient selection of therapies and satisfaction with treatment.
"These results underscore the importance of incorporating patients' preferences in treatment decisions," according to Carolyn M. Clancy, M.D., director of AHRQ's Center on Outcomes and Effectiveness Research. "Assessment of quality health care should take into account the interactions between the physician and patient in deciding which treatment to pursue."
This is one of the first large studies of breast cancer treatment to focus on older women that includes a defined stage of the disease and detailed information about patient, clinical, physician, and other factors affecting treatment patterns. Future research is needed to determine the appropriate clinical approach to treating breast cancer in the very old, and to include the under-represented older population in future clinical trials.
Details are in the August 1 Cancer journal article: "Patterns of Breast Carcinoma Treatment in Older Women: Patient Preference and Clinical and Physician Influences" by Jeanne S. Mandelblatt, M.D., M.P.H.; Jack Hadley, Ph.D.; Jon F. Kerner, Ph.D.; Kevin A. Schulman, M.D.; and others.
Editor's Note: For more details or to interview Dr. Mandelblatt, please contact her at (202) 687-0812 or (202) 687-8950.
For more information, contact AHRQ Public Affairs (301) 427-1364.