Meresse Mégane, Bouhnik Anne-Déborah, Bendiane Marc-Karim, Retornaz Frédérique, Rousseau Frédérique, Rey Dominique, Giorgi Roch
Aix Marseille University, INSERM, IRD, SESSTIM "Economics and Social Sciences Applied to Health & Analysis of Medical Information", Marseille, France.
ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
Breast J. 2017 May;23(3):256-266. doi: 10.1111/tbj.12726. Epub 2016 Dec 31.
Breast cancer affects mostly older women but there are no guidelines especially devoted to adjuvant chemotherapy for this population. In this context, this study was carried out in a population-based cohort of French elderly women with breast cancer, to check adherence to the existing national guidelines according to the women's age, taking into account the evolution of the situation over time for women requiring chemotherapy. Between October 2006 and December 2008, all consecutive women included in the French Health registry for a biopsy-proven primary nonmetastatic breast cancer, aged 65-80 years at diagnosis, and living in South Eastern France, were asked to participate in a cohort study. Medical information was collected from physicians. The study population was restricted to the 223 women who were recommended adjuvant chemotherapy according to national guidelines. Those who received chemotherapy were compared to those who did not receive this treatment. Among these 223 women 55% had received chemotherapy. Only three women refused the treatment. Less than 8% have had a geriatric assessment before treatment decision and only two were proposed to participate in a clinical trial. After adjustment for comorbidity score, tumor characteristics, socio-demographic characteristics, and year of diagnosis, increasing patient age was independently associated with decreased guideline concordance for adjuvant chemotherapy. Women aged 75-80 years received chemotherapy more than four times less often than women aged 65-74 years. However, the percentage of women who received chemotherapy increased from 33% to 58% between 2006 and 2008, in parallel with the setting up of Onco-Geriatric Coordination Units in the area. In France, chronological age remains a barrier to receive chemotherapy for older breast cancer women but the establishment of a formal collaboration between oncologists and geriatricians seems to be an effective way to improve care delivery in this population.
乳腺癌主要影响老年女性，但目前尚无专门针对该人群辅助化疗的指南。在此背景下，本研究在一个基于人群的法国老年乳腺癌女性队列中开展，旨在根据女性年龄检查对现有国家指南的遵循情况，并考虑到需要化疗的女性情况随时间的变化。2006年10月至2008年12月期间，所有在法国健康登记处登记的、经活检证实为原发性非转移性乳腺癌、诊断时年龄在65 - 80岁且居住在法国东南部的连续女性，均被邀请参与一项队列研究。医疗信息从医生处收集。研究人群仅限于根据国家指南建议进行辅助化疗的223名女性。将接受化疗的女性与未接受该治疗的女性进行比较。在这223名女性中，55%接受了化疗。只有三名女性拒绝了治疗。在治疗决策前进行老年评估的女性不到8%，仅有两名女性被提议参加临床试验。在对合并症评分、肿瘤特征、社会人口学特征和诊断年份进行调整后，患者年龄增加与辅助化疗的指南一致性降低独立相关。75 - 80岁的女性接受化疗的频率比65 - 74岁的女性低四倍多。然而，2006年至2008年期间，接受化疗的女性比例从33%增至58%，与此同时该地区设立了老年肿瘤协调单位。在法国，实际年龄仍然是老年乳腺癌女性接受化疗的障碍，但肿瘤学家和老年病学家之间建立正式合作似乎是改善该人群护理服务的有效途径。
