Hurria Arti, Naeim Arash, Elkin Elena, Limaye Sewanti, Grover Anjali, Hudis Clifford, Pearce Carol, Robson Mark
Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Crit Rev Oncol Hematol. 2007 Mar;61(3):255-60. doi: 10.1016/j.critrevonc.2006.09.002. Epub 2006 Nov 13.
Previous studies demonstrate differing treatment patterns between older and younger patients with breast cancer. To explore the reasons for these disparities we conducted a survey of 28 oncologists specializing in breast cancer.
Twenty-eight medical oncologists from Memorial Sloan-Kettering Cancer Center and the University of California Los Angeles who specialize in the treatment of breast cancer were asked to provide adjuvant treatment recommendations in hypothetical scenarios featuring older patients with high-risk breast cancer. For each of these hypothetical patients, the patient's age was varied over four possible values (70, 75, 80, or 85 years of age) and health and functional status varied across three possible states (perfect health, average health, or major health problems). Survey data were compiled and analyzed to determine the impact of theoretical patient age, baseline health, and functional status on their treatment recommendations.
The proportion of oncologists who recommended adjuvant chemotherapy decreased as the patient's age increased or as the patient's functional status and health status decreased. For 96% of physicians (95% CI, 82-100%), patient age influenced chemotherapy recommendations, controlling for health/functional status; the same proportion of respondents were influenced by health/functional status, controlling for patient age. There was increased variability in treatment recommendations as the patient's age increased or functional status and health status decreased.
Among these medical oncologists who primarily treat breast cancer adjuvant treatment recommendations vary based on patient age, health, and functional status. Future studies are needed to correlate age, health, and functional status with the risks and benefits of adjuvant therapy so that consensus guidelines can be formed. A more comprehensive baseline assessment of the older patient, such as can be derived from a comprehensive geriatric assessment may be useful in this regard.
既往研究表明，老年和年轻乳腺癌患者的治疗模式存在差异。为探究这些差异的原因，我们对28位乳腺癌专科肿瘤学家进行了一项调查。
来自纪念斯隆凯特琳癌症中心和加利福尼亚大学洛杉矶分校的28位专门从事乳腺癌治疗的医学肿瘤学家，被要求在以老年高危乳腺癌患者为特征的假设情景中提供辅助治疗建议。对于每一位这样的假设患者，患者年龄在四个可能值（70、75、80或85岁）之间变化，健康和功能状态在三种可能状态（完全健康、一般健康或有重大健康问题）之间变化。对调查数据进行整理和分析，以确定理论上的患者年龄、基线健康状况和功能状态对其治疗建议的影响。
随着患者年龄增加或功能状态及健康状况下降，推荐辅助化疗的肿瘤学家比例降低。在96%的医生中（95%可信区间，82 - 100%），在控制健康/功能状态的情况下，患者年龄影响化疗建议；相同比例的受访者在控制患者年龄的情况下受到健康/功能状态的影响。随着患者年龄增加或功能状态及健康状况下降，治疗建议的变异性增加。
在这些主要治疗乳腺癌辅助治疗的医学肿瘤学家中，治疗建议因患者年龄、健康状况和功能状态而异。需要进一步研究将年龄、健康状况和功能状态与辅助治疗的风险和益处相关联，以便形成共识指南。在这方面，对老年患者进行更全面的基线评估，例如可以从综合老年评估中得出的评估，可能会有所帮助。
