Goodwin J S, Hunt W C, Samet J M
Department of Medicine, University of New Mexico School of Medicine, Albuquerque.
Cancer. 1993 Jul 15;72(2):594-601. doi: 10.1002/1097-0142(19930715)72:2<594::aid-cncr2820720243>3.0.co;2-#.
Older patients with cancer are less likely to receive definitive therapy, but the reasons for this are unclear.
All people aged 65 years or older living in six counties in New Mexico and diagnosed with breast, prostate, or colorectal cancer between May 15, 1984 and May 15, 1986 (N = 669) were interviewed to obtain information on demographics, socioeconomic status, functional status, social support, other medical conditions, and cognitive status. Cancer treatment information was obtained from the New Mexico Tumor Registry.
In univariate analyses, the following variables were associated significantly with nonreceipt of definitive therapy for cancer: advanced age, impairment in activities of daily living, low physical activity, decreased mental status, impaired access to transportation, and poor social support. In a multivariate analysis with the above variables along with measures of comorbidity, only advanced age and decreased mental status remained significant predictors of nonreceipt of definitive surgery, whereas the effects of impaired access to transportation and low physical activity remained relatively large but no longer were statistically significant. When receipt of surgery and receipt of radiation therapy were considered separately, older age, limited access to transportation, impaired functional status, and impaired mental status all significantly predicted nonreceipt of radiation therapy, but not surgery.
There is a decline with age in the percentage of adults with cancer who received definitive therapy independent of other potentially explanatory factors such as comorbidity. In addition, decisions about radiation may be influenced by nonmedical, potentially correctable factors such as impaired access to transportation.
老年癌症患者接受根治性治疗的可能性较小，但其原因尚不清楚。
对居住在新墨西哥州六个县、年龄在65岁及以上、于1984年5月15日至1986年5月15日期间被诊断为乳腺癌、前列腺癌或结直肠癌的所有人（N = 669）进行访谈，以获取有关人口统计学、社会经济地位、功能状态、社会支持、其他医疗状况和认知状态的信息。癌症治疗信息来自新墨西哥肿瘤登记处。
在单因素分析中，以下变量与未接受癌症根治性治疗显著相关：高龄、日常生活活动能力受损、身体活动量低、精神状态下降、交通不便以及社会支持差。在对上述变量以及合并症指标进行的多因素分析中，只有高龄和精神状态下降仍然是未接受根治性手术的显著预测因素，而交通不便和身体活动量低的影响仍然相对较大，但不再具有统计学意义。当分别考虑手术接受情况和放射治疗接受情况时，高龄、交通不便、功能状态受损和精神状态受损均显著预测未接受放射治疗，但不预测未接受手术。
与其他潜在解释因素如合并症无关，接受根治性治疗的成年癌症患者比例随年龄增长而下降。此外，关于放射治疗的决策可能受到非医疗、可能可纠正的因素影响，如交通不便。
