Morrow Elizabeth S, Dolan Ross D, Doughty Julie, Stallard Sheila, Lannigan Alison, Romics Laszlo
Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
Department of Surgery, Gartnavel General Hospital, Glasgow, UK.
Breast Cancer (Dove Med Press). 2019 May 8;11:179-188. doi: 10.2147/BCTT.S194124. eCollection 2019.
Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found. Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient's electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams. 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures. A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.
研究表明，老年乳腺癌患者接受的治疗不如年轻患者积极。有证据表明，不同机构对他们的治疗方式存在差异。我们对格拉斯哥两个相邻科室的老年患者治疗情况进行了审计，旨在找出发现的实践差异的原因。从一个前瞻性维护的数据库中识别出2009年至2013年期间在这两个科室接受新诊断乳腺癌治疗的70岁及以上患者。肿瘤病理、治疗细节、邮政编码和负责护理的顾问信息均来自同一个数据库。共病情况从每位患者的电子临床记录中获取。向每个多学科团队的成员发放了问卷。在第一科室识别出487名老年患者，在第二科室识别出467名。第一科室76.2%的患者接受了手术治疗，而第二科室为63.7%（<0.0001）。两个科室在患者年龄、肿瘤病理、贫困程度或共病情况方面没有差异。在第一科室接受手术治疗的患者中，16.2%的患者共病评分为6分及以上，而在第二科室接受手术治疗的患者中这一比例为11%（=0.036）。问卷回复表明，第一科室的工作人员对老年患者全身麻醉的安全性更有信心，也更愿意考虑局部麻醉手术。与第二科室相比，第一科室中年龄>70岁的乳腺癌患者接受手术治疗的比例更高。实践差异的原因似乎与医学专业人员对老年患者手术的态度有关，而非患者或病理因素。
