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ARTICLE

Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer

Xianglin L. Du, MD, PhD; Charles R. Key, MD, PhD; Cynthia Osborne, MD; Jonathan D. Mahnken, MS; and James S. Goodwin, MD

21 January 2003 | Volume 138 Issue 2 | Pages 90-97

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.

Editors' Notes Context National Institutes of Health consensus guidelines recommend adjuvant chemotherapy for premenopausal or postmenopausal women with node-positive tumors or node-negative breast tumors greater than 1 cm, regardless of hormone receptor status. The actual (and age-specific) use of chemotherapy in women with breast cancer is unknown. Contribution Using data from the New Mexico Tumor Registry, these investigators show that chemotherapy is used much less frequently than recommended and that frequency decreases sharply with advancing age. Implications Since only a minority of postmenopausal women receive adequate treatment for breast cancer, many unnecessary deaths could probably be prevented by following the National Institutes of Health guidelines. –The Editors

 

Author and Article Information

From University of Texas Medical Branch, Galveston, Texas; and University of New Mexico, Albuquerque, New Mexico.

Grant Support: By grants from the National Cancer Institute (R01-CA90626 and R01-CA871773) and the Sealy and Smith Foundation, Galveston, Texas.

Requests for Single Reprints: Xianglin L. Du, MD, PhD, Department of Internal Medicine, 3.134 Jennie Sealy Hospital, University of Texas Medical Branch, Galveston, TX 77555-0460; e-mail, xdu{at}utmb.edu.

Current Author Addresses: Drs. Du, Osborne, and Goodwin: Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555.

Dr. Key: New Mexico Tumor Registry, University of New Mexico Health Sciences Center, 2325 Camino de Salud NE, Albuquerque, NM 87131.

Mr. Mahnken: Sealy Center on Aging (Biostatistics), University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555.

Author Contributions: Conception and design: X.L. Du, C.R. Key, J.S. Goodwin.

Analysis and interpretation of the data: X.L. Du, J.D. Mahnken, J.S. Goodwin.

Drafting of the article: X.L. Du.

Critical revision of the article for important intellectual content: X.L. Du, C. Osborne, J.D. Mahnken, J.S. Goodwin.

Final approval of the article: X.L. Du, C.R. Key, C. Osborne, J.D. Mahnken, J.S. Goodwin.

Provision of study materials or patients: X.L. Du, C.R. Key.

Statistical expertise: X.L. Du, J.D. Mahnken.

Obtaining of funding: X.L. Du, C.R. Key, J.S. Goodwin.

Administrative, technical, or logistic support: X.L. Du, C.R. Key.

Collection and assembly of data: X.L. Du, C.R. Key.

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