Elderly women with breast cancer whose surgeons refer them to cancer specialists are twice as likely to be prescribed tamoxifen, a treatment recommended for preventing recurrence of the disease, a new study shows.
“Older women should be given the opportunity to have these conversations with medical oncologists,” Dr. Rebecca A. Silliman of the Boston University School of Public Health, the study’s lead author, told Reuters Health.
While tamoxifen has long been recommended for older women with estrogen-receptor-positive breast cancers, except those with extremely low-risk tumors, older women are less likely than younger patients to receive definitive care, Silliman and her colleagues note in the medical journal Cancer.
Silliman’s team conducted the current study to see if older women who met with a medical oncologist were more likely to be prescribed tamoxifen therapy when appropriate.
The study included 559 patients 65 years of age or older with early-stage breast cancer treated by 191 surgeons. The women were interviewed by telephone 3, 6 and 15 months after surgery.
Seventy-nine percent of the participants had been referred to medical oncologists, somewhat lower than the 88 percent seen among younger patients in other research, the investigators report. Sicker patients were roughly half as likely to be referred as healthier patients.
There is “growing evidence,” the researchers note, that variations in cancer care seen with age may lead to worse outcomes for older people. “Our findings suggest that more consistent referral of older women to medical oncologists may enhance the quality of discussions and decisions concerning treatment options,” they conclude.
“The main implication is that treatment decision-making in cancer, whether it’s breast cancer or any other kind of cancer, is complex and obviously emotionally charged,” Silliman added.
“I think offering older women the same kind of opportunity for treatment decision-making conversations is really important, because many of these women have a substantial future life expectancy,” she concluded.