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Advanced age and adjuvant tamoxifen prescription in early‐stage breast carcinoma patients
Author(s) -
Blackman Sarah B.,
Lash Timothy L.,
Fink Aliza K.,
Ganz Patricia A.,
Silliman Rebecca A.
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10985
Subject(s) - medicine , tamoxifen , breast cancer , confounding , breast carcinoma , comorbidity , medical prescription , gynecology , cancer , oncology , pharmacology
BACKGROUND Adjuvant tamoxifen is recommended for all women with estrogen receptor‐positive breast carcinoma without regard for age. We investigated age‐dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older. METHODS We studied 92 women diagnosed at four U.S. sites with primary, early‐stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85–92 years of age with those received by women 80–84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed. RESULTS Before adjustment, patients 85–92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80–84 years of age (RR = 0.72, 95% CI 0.57–0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58–0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59–0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed. CONCLUSION Given the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality. Cancer 2002;95:2465–72. © 2002 American Cancer Society. DOI 10.1002/cncr.10985