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Adjuvant Tamoxifen Prescription in Women 65 Years and Older With Primary Breast Cancer

From the Department of Medicine, Boston University School of Medicine, Department of Epidemiology and Biostatistics, Boston University School of Public Health, and Department of Health Care Policy, Harvard Medical School, Boston, and Meyers Primary Care Institute, Fallon Healthcare System and the University of Massachusetts School of Medicine, Worcester, MA; Department of Community Health, Brown University, Providence, RI; University of California Los Angeles Schools of Medicine and Public Health, Los Angeles, CA; and Healthcare Education and Research Foundation, Inc, St. Paul, MN.

Address reprint requests to Rebecca A. Silliman, MD, PhD, Boston Medical Center, 88 East Newton St, F4, Boston, MA 02118; email: rsillima{at}bu.edu

PURPOSE: We examined patterns of adjuvant tamoxifen discussion and prescription among breast cancer patients age 65 years and older.

METHODS: We selected from women diagnosed with primary breast cancer those with (1) stage I (tumor diameter 1 cm), stage II, or stage IIIa disease; (2) age 65 years or older on the date of diagnosis; and (3) permission from the attending physician to contact. Data were collected from consenting patients’ medical records, telephone interviews with patients, and mailed questionnaires completed by their physicians.

RESULTS: We obtained medical record and interview data for 698 patients. The oldest patients (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.23 to 0.87 for those aged 80+ relative to those aged 65 to 69 years old), those with more comorbid conditions (each additional comorbid condition reduced the odds of discussion by 0.84; 95% CI, 0.73 to 0.96), and those who were estrogen receptor–negative (OR, 0.56; 95% CI, 0.32 to 0.99) were less likely to report discussion of tamoxifen therapy with a physician. Older patients (OR, 2.17; 95% CI, 1.18 to 4.01 for 70- to 79-year-olds relative to 65- to 69-year-olds; OR, 2.44; 95% CI, 1.11 to 5.34 for those aged 80+ relative to those aged 65 to 69 years old), those who reported a greater influence of information about tamoxifen on decision-making (an increase in 1 SD increased the odds by 7.43; 95% CI, 4.36 to 12.65), and those whose physicians believed that the benefits of tamoxifen outweighed its risks (an increase in 1 SD increased the odds by 1.87; 95% CI, 1.34 to 2.62) were more likely to be prescribed tamoxifen.

CONCLUSION: These findings highlight the key role of communication in the care of older women with breast cancer and its ultimate influence on the receipt of therapy.

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