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. 2009 Sep 20;27(27):4508-14.
doi: 10.1200/JCO.2008.18.3459. Epub 2009 Aug 17.

Referral, receipt, and completion of chemotherapy in patients with early-stage breast cancer older than 65 years and at high risk of breast cancer recurrence

Diana S M Buist  1 , Jessica Chubak, Marianne Prout, Marianne Ulcickas Yood, Jaclyn L F Bosco, Soe Soe Thwin, Heather Taffet Gold, Cynthia Owusu, Terry S Field, Virginia P Quinn, Feifei Wei, Rebecca A Silliman
Affiliations

Referral, receipt, and completion of chemotherapy in patients with early-stage breast cancer older than 65 years and at high risk of breast cancer recurrence

Diana S M Buist et al. J Clin Oncol. .

Abstract

Purpose: Some women with early-stage breast cancer are at higher risk of recurrence and can benefit from chemotherapy. We describe patterns of referral, receipt, and completion of chemotherapy among older women at high risk of recurrence.

Patients and methods: A total of 2,124 women age 65 years or older who were diagnosed with early-stage breast cancer between 1990 and 1994 and 1996 to 1999 were included; 1,090 of these were at high risk of recurrence. We reviewed medical records to categorize chemotherapy outcomes as follows: did not discuss or were not referred to a medical oncologist (n = 133); discussed and/or referred to a medical oncologist but received no chemotherapy (n = 742); received an incomplete chemotherapy course (n = 29), or received a completed chemotherapy course (n = 186).

Results: Overall, 19.7% of high-risk women received any chemotherapy, and 86.5% of these women completed their chemotherapy courses. Just greater than 10% of high-risk women did not have a discussion about chemotherapy as part of breast cancer treatment documented in the medical record; these women also received fewer diagnostic assessments of their initial tumors.

Conclusion: Individuals who receive chemotherapy for early-stage breast cancer are a select subgroup of patients at high risk of recurrence. This study identifies characteristics of women who were referred for and who received chemotherapy, and this study plays an important role in understanding generalizability of studies that examine chemotherapy treatment effectiveness. Outcomes after breast cancer could continue to be improved with increased receipt of chemotherapy among older women at high risk of breast cancer recurrence.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Tumor characteristics of 2,124 women aged 65 years or older who were diagnosed between 1990 and 1994 and 1996 to 1999 with incident, invasive, early-stage (ie, stages I to II) breast cancer stratified by nodal status, differentiation (diff), estrogen receptor (ER) status, and tumor size. Of these women, 1,090 were in high-risk subgroups (8 boxes with the number of women in each subgroup and the percent of those who received any chemotherapy). (*) Women considered at high risk of recurrence, in whom chemotherapy could have been considered.–
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