Originally published as JCO Early Release 10.1200/JCO.2008.17.6891 on October 27 2008

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Role of Age and Health in Treatment Recommendations for Older Adults With Breast Cancer: The Perspective of Oncologists and Primary Care Providers

Arti Hurria, F. Lennie Wong, Doojduen Villaluna, Smita Bhatia, Cathie T. Chung, Joanne Mortimer, Sara Hurvitz, Arash Naeim

From the City of Hope National Medical Center, Duarte; and the University of California, Los Angeles, Los Angeles, CA

Corresponding author: Arti Hurria, MD, City of Hope, 1500 E Duarte Road, Duarte, CA 91010; e-mail: ahurria{at}coh.org

Purpose To determine the impact of age and health status on adjuvant treatment recommendations for older patients with breast cancer from the perspective of medical oncologists and primary care physicians with geriatric expertise.

Patients and Methods One hundred fifty-one oncologists and 158 primary care physicians with geriatric expertise participated in an online survey. The survey described hypothetical patients of varying ages (70, 75, 80, and 85 years) and health status (good, average, and poor) who had node-positive, hormone receptor–positive, human epidermal growth factor receptor 2 (HER-2)/neu–negative; and hormone receptor–negative, HER-2/neu–positive breast cancers. The effects of patient age and health status on the survey participants’ adjuvant treatment recommendations were examined using generalized estimation equation methods.

Results The majority of both oncologists and primary care physicians recommended some form of adjuvant therapy for patients of all ages (70, 75, 80, and 85 years) and health status. Both oncologists and primary care providers were less likely to recommend adjuvant treatment as a patient's age increased or health status declined (P < .0001). There were no significant differences in treatment recommendations among primary care physicians and oncologists for patients with hormone receptor–negative, HER-2/neu–positive tumors (P = .54). However, primary care providers were more likely than oncologists to recommend no adjuvant treatment for patients age 75 years or older with hormone receptor–positive, HER-2/neu–negative tumors (P < .01).

Conclusion Age and health status influence oncologists’ and primary care providers’ adjuvant treatment recommendations. Evidence-based guidelines for breast cancer treatment in older adults taking into account age and health status are needed.

published online ahead of print at www.jco.org on October 27, 2008

Supported by the Paul Beeson Career Development Award in Aging Research (Grant No. K23 AG026749-01) and American Society of Clinical Oncology Association of Specialty Professors Junior Development Award in Geriatric Oncology (both to A.H.); National Institutes of Health Grant No. 1K23CA102149 (A.N.); and Pfizer.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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