Newcomb P A, Carbone P P
University of Wisconsin-Madison Comprehensive Cancer Center, Madison 53706.
J Natl Cancer Inst. 1993 Oct 6;85(19):1580-4. doi: 10.1093/jnci/85.19.1580.
Despite some evidence that age does not meaningfully influence the efficacy or toxicity of cancer treatment, older patients tend to receive less comprehensive cancer therapies.
We conducted a population-based study to evaluate the selection of cancer treatment among the elderly.
Between September 1 and November 30, 1990, we interviewed by telephone a sample of 628 female Wisconsin residents recently diagnosed with breast (507) or colorectal (121) cancer. The women, aged 20-74 at the time of diagnosis, were identified through Wisconsin's statewide tumor registry. The approximately 30-minute long telephone interview, part of a larger study of cancer etiology, included questions on treatment history, physician specialty, and reasons for the selection of specific therapies. Analyses compared the proportion of subjects with various treatment characteristics according to age (< 65 and > or = 65 years). In evaluating the effect of age on selected therapies, we adjusted summary proportions for stage of disease using the indirect method. The Mantel-Haenszel chi square statistic was used to evaluate statistical significance of the differences in proportions.
After adjusting for stage of disease at diagnosis, substantial variation was observed in cancer treatment according to age for both breast and colorectal cancer. Older women (> or = 65 years) with breast cancer were less likely than younger women (< 65 years) to have received conservative surgery, radiation, and adjuvant therapy. Older women were, in fact, more likely than younger women to accept mastectomy (P = .03). Consultation with a medical or radiation oncologist was less common among older than younger patients (57% versus 73%). Older women were also less likely to have alternative therapies presented to them (19% versus 31%). While older patients were less likely to have been offered adjuvant treatments, like chemotherapy (P < .01), they were also more likely than younger women to reject these treatments when offered (P = .01). These differences were observed in both breast and colorectal cancer patients. Regardless of age, the most common reasons for not selecting treatments were physicians' recommendations and the desire for more comprehensive treatment. Concern about side effects, however, was more frequently reported by older women (P = .07).
Patients' ages influence the choice of treatment. Physicians offer older women with cancer different treatments from those offered to younger women and are less likely to recommend specialist consultation. Physicians' advice and description of toxicity may influence patients' selection of treatment. However, older patients' concerns about the consequences of cancer treatment may also influence treatment choice.
尽管有证据表明年龄对癌症治疗的疗效或毒性并无显著影响，但老年患者往往接受的癌症综合治疗较少。
我们开展了一项基于人群的研究，以评估老年人癌症治疗的选择情况。
1990年9月1日至11月30日期间，我们通过电话访谈了628名最近被诊断患有乳腺癌（507例）或结直肠癌（121例）的威斯康星州女性居民。这些女性在诊断时年龄为20 - 74岁，通过威斯康星州全州肿瘤登记处确定。这次约30分钟的电话访谈是一项关于癌症病因的更大规模研究的一部分，包括治疗史、医生专业以及选择特定治疗方法的原因等问题。分析比较了不同年龄组（<65岁和≥65岁）具有各种治疗特征的受试者比例。在评估年龄对所选治疗方法的影响时，我们使用间接方法对疾病分期的汇总比例进行了调整。采用Mantel - Haenszel卡方统计量来评估比例差异的统计学显著性。
在对诊断时的疾病分期进行调整后，乳腺癌和结直肠癌的癌症治疗情况根据年龄均存在显著差异。患有乳腺癌的老年女性（≥65岁）比年轻女性（<65岁）接受保乳手术、放疗和辅助治疗的可能性更小。事实上，老年女性比年轻女性更有可能接受乳房切除术（P = 0.03）。老年患者比年轻患者更不常咨询医学或放射肿瘤学家（57%对73%）。老年女性也较少有人向她们介绍替代疗法（19%对31%）。虽然老年患者接受辅助治疗如化疗的可能性较小（P < 0.01），但当提供这些治疗时，她们拒绝的可能性也比年轻女性更大（P = 0.01）。这些差异在乳腺癌和结直肠癌患者中均有观察到。无论年龄大小，不选择治疗的最常见原因是医生的建议以及希望接受更全面的治疗。然而，老年女性更频繁地报告担心副作用（P = 0.07）。
患者年龄会影响治疗选择。医生为老年癌症女性提供的治疗与年轻女性不同，且不太可能推荐专科会诊。医生的建议和对毒性的描述可能会影响患者的治疗选择。然而，老年患者对癌症治疗后果的担忧也可能影响治疗选择。
