Greenfield S, Blanco D M, Elashoff R M, Ganz P A
JAMA. 1987;257(20):2766-70.
We performed a chart review study to determine whether physicians provided less vigorous treatment for elderly patients with breast cancer than for younger patients. Seven hospitals, varying with respect to size, medical school affiliation, and patient socioeconomic status participated in this study. Patterns of breast cancer care were compared with a set of branching logic standards in the form of a criteria map. A chart-based comorbidity index was developed to control for the influence of coexisting diseases on cancer management. Logistic regression analysis of 374 breast cancer cases revealed that both patient age and comorbidity status significantly and independently affected treatment. Among stage I and II patients with no or very mild comorbid disease, 96% of those aged 50 to 69 years received appropriate surgery vs 83% of patients aged 70 years and older. We conclude that physicians may manage patients with this highly treatable disease according to chronologic age without regard for physiological condition and that this age bias may result in a less favorable prognosis than could be achieved using currently recommended therapy.
我们进行了一项病历回顾研究，以确定医生对老年乳腺癌患者的治疗力度是否小于年轻患者。七家医院参与了这项研究，这些医院在规模、医学院附属关系和患者社会经济地位方面各有不同。乳腺癌护理模式与以标准地图形式呈现的一组分支逻辑标准进行了比较。开发了基于病历的合并症指数，以控制并存疾病对癌症治疗的影响。对374例乳腺癌病例的逻辑回归分析显示，患者年龄和合并症状态均对治疗有显著且独立的影响。在无合并症或合并症非常轻微的I期和II期患者中，50至69岁的患者中有96%接受了适当的手术，而70岁及以上的患者中这一比例为83%。我们得出结论，医生可能会根据实际年龄来治疗这种高度可治性疾病的患者，而不考虑生理状况，并且这种年龄偏见可能导致预后不如采用当前推荐疗法所能达到的预后。
