Temporal and Regional Variability in the Surgical Treatment of Cancer Among Older People

Farrow, Diana C.; Hunt, William C.; Samet, Jonathan M.

doi:10.1111/j.1532-5415.1996.tb01442.x

Cited by 18 publications

(4 citation statements)

References 29 publications

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“…Several studies have reported that elderly women diagnosed with breast carcinoma consistently receive less aggressive treatment for their disease 1–14. This conservative therapeutic attitude could be justified on several grounds.…”

mentioning

confidence: 99%

Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Hébert‐Croteau¹,

Brisson

Latreille

et al. 1999

Cancer

183

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BACKGROUND The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received. METHODS A stratified random sample was selected among women age ≥ 50 newly diagnosed with lymph node negative breast carcinoma in Québec in 1988, 1991, and 1993. Information was abstracted from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast‐conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple logistic regression analysis. RESULTS Overall, 1174 patients age ≥ 50 years with breast carcinoma were included. Women age ≥ 70 years were much less likely to receive definitive locoregional treatment compared with women ages 50–69 years (48.7% vs. 83.5%; P < 0.0001). Older women were less likely to undergo surgery with breast preservation (76.7% vs. 86.3%; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 64.7%; P = 0.41). Adjusting for comorbidity and other characteristics related to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12–0.18 for women age ≥ 70 years vs. women ages 50–69 years). The same association was observed when women who did not undergo lymph node dissection but who received systemic adjuvant treatment were considered to have received definitive therapy (OR, 0.13; 95% CI, 0.10–0.17) for women age ≥ 70 years vs. women ages 50–69 years). CONCLUSIONS Less aggressive patterns of care are provided to elderly breast carcinoma patients, independent of comorbidity. This could explain, at least in part, the sustained breast carcinoma mortality in this population. Cancer 1999;85:1104–13. © 1999 American Cancer Society.

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mentioning

confidence: 99%

Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Hébert‐Croteau¹,

Brisson

Latreille

et al. 1999

Cancer

183

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“…The reasons for this phenomenon include, among others, a higher level of co-morbidity, which may affect treatment choices, and which has been shown to be of prognostic relevance [20] (although co-morbidity should affect relative survival rates much less than absolute survival rates), less favourable stage distribution, and less aggressive treatment among older patients (independently of comorbidity) [21,22]. For example, it has been shown that older cancer patients are less likely to be referred to specialist care [23], and to receive definitive therapy, such as surgical treatment [24], chemotherapy [25] or radiation [21] than younger patients. Furthermore, differences in tumor biology and aggressiveness are also likely to play a role for some forms of cancer [26,27].…”

Section: Discussionmentioning

confidence: 96%

Recent increase in cancer survival according to age: higher survival in all age groups, but widening age gradient

Brenner¹,

Arndt²

2004

Cancer Causes Control

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A major increase in long-term survival of cancer patients in the 1990s has recently been demonstrated. It is unclear, however, to what extent this increase has been shared by cancer patients at various ages. Using the 1973-2000 data base of the Surveillance, Epidemiology, and End Results programme, recent increase in 10-year relative survival of cancer patients in the US was assessed for 4 major age groups and 15 major cancer sites by comparing results of a period analysis for the 1996-2000 period with results of a cohort analysis for patients diagnosed in 1986-1990. Period estimates of 10-year relative survival for all forms of cancer combined in 1996-2000 were 66.1%, 58.8%, 56.3% and 47.1% for age groups 15-54, 55-64, 65-74 and > or = 75 years, respectively. They were 7.4%, 10.4%, 7.8% and 3.0% units higher than the respective 1986-1990 cohort estimates for these age groups. The increase in 10-year relative survival strongly varied by cancer site, but it was generally less pronounced in older than in younger patients. We conclude that long-term survival expectations of cancer patients have increased in all age groups in the 1990s. However, for most common forms of cancer, the age gradient in survival has either persisted or widened.

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“…2 Encouragingly, there seems to be a trend for increased surgical treatment and survival of elderly patients in recent years. 15…”

Section: Treatmentmentioning

confidence: 99%

Cancer in old age: is it inadequately investigated and treated?

1999

Nursing Older People

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Temporal and Regional Variability in the Surgical Treatment of Cancer Among Older People

Abstract: Although older people remain less likely to receive surgical therapy than younger persons, for some important cancer sites the gap between the treatment of older and younger individuals narrowed from 1973 through 1991.

Cited by 18 publications

References 29 publications

Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Recent increase in cancer survival according to age: higher survival in all age groups, but widening age gradient

Cancer in old age: is it inadequately investigated and treated?

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