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. 2003 Jan 21;138(2):90-7.
doi: 10.7326/0003-4819-138-2-200301210-00009.

Discrepancy between consensus recommendations and actual community use of adjuvant chemotherapy in women with breast cancer

Xianglin L Du  1 , Charles R Key, Cynthia Osborne, Jonathan D Mahnken, James S Goodwin
Affiliations

Discrepancy between consensus recommendations and actual community use of adjuvant chemotherapy in women with breast cancer

Xianglin L Du et al. Ann Intern Med. .

Erratum in

  • Ann Intern Med. 2003 Nov 18;139(10):873

Abstract

Background: Although the efficacy of adjuvant chemotherapy in prolonging survival for women with breast cancer has been well documented, limited population-based information is available on the actual use of chemotherapy.

Objective: To examine the relationship between age and chemotherapy use.

Design: Cohort study.

Setting: New Mexico.

Patients: 5101 women 20 years of age or older receiving a diagnosis of stage I, stage II, or stage IIIA breast cancer from 1991 through 1997.

Measurements: Pattern of chemotherapy use by age; logistic regression analysis to generate the odds and probabilities of receiving chemotherapy; and sensitivity analysis to estimate potential effects of unmeasured confounders.

Results: Overall, 29% of women received chemotherapy. The rate of chemotherapy use for women with stage I, stage II, or stage IIIA breast cancer was 11%, 47%, and 68%, respectively. Across all tumor stages, the use of chemotherapy decreased substantially with increasing age (P < 0.001). Overall, 66% of women younger than 45 years of age received chemotherapy compared with 44% of women between 50 and 54 years of age, 31% of women between 55 and 59 years of age, and 18% of women between 60 and 64 years of age. The decreasing pattern of chemotherapy use with age continued after adjustment for prognostic factors and was relatively insensitive to changes in unmeasured factors.

Conclusions: There is considerable discrepancy between the 1990 National Institutes of Health Consensus Conference recommendations for chemotherapy administration in women with breast cancer and the actual use of chemotherapy in the community. The decrease in use with age may relate to the decreasing efficacy of chemotherapy with age, as reported in clinical trials. Outcomes studies should address whether the recommendations are overly aggressive or whether practicing oncologists are too conservative in their use of chemotherapy.

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Figures

Figure
Figure. Receipt of adjuvant chemotherapy as a function of age and tumor characteristics in women with breast cancer
Women with stage I, stage II, or stage IIIA breast cancer are categorized into two groups based on their tumor characteristics—characteristics for which the 1990 National Institute of Health (NIH) Consensus Conference (3) generally recommended chemotherapy (n = 2486; dotted line) and characteristics for which the consensus conference recommended decisions on an individual, discretionary basis (n = 2615; solid line). The 2000 NIH Consensus Conference recommended chemotherapy for all breast tumors 1.0 cm or larger in size; however, these recommendations were made after we conducted our study. For women 70 to 74 years of age and women 75 years of age and older, the NIH Consensus Conference made no specific consensus recommendations on treatment with chemotherapy.
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Comment in

  • Chemotherapy in women with breast cancer.
    Liebmann J, Haskins C, McAneny B, Giudice R, Clark D, Marshall N. Liebmann J, et al. Ann Intern Med. 2003 Nov 18;139(10):867-8; author reply 868-9; discussion 869. doi: 10.7326/0003-4819-139-10-200311180-00024. Ann Intern Med. 2003. PMID: 14623631 No abstract available.
  • Chemotherapy in women with breast cancer.
    Harlan LC, Clegg LX, Warren JL. Harlan LC, et al. Ann Intern Med. 2003 Nov 18;139(10):868; author reply 868-9. doi: 10.7326/0003-4819-139-10-200311180-00025. Ann Intern Med. 2003. PMID: 14623632 No abstract available.

Summary for patients in

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