Abstract
Background. Despite evidence regarding the effectiveness of post-surgical treatments for early-stage
breast cancer, older women are less likely to receive appropriate therapy. We evaluated
the impact of surgeon-specific “performance reports” on adherence to treatment guidelines
among older women with breast cancer. Methods. We obtained diagnostic and treatment data from hospital tumor registries supplemented
with self-reported adjuvant therapy information on 1099 patients with stage I or II
breast cancer diagnosed between November 1, 1992, and January 31, 1997, at 6 Rhode
Island hospitals.We compared rates of appropriate treatment receipt before and after
distribution of performance reports. Hierarchical analysis was used to account for
the nesting of patients within surgeons. Separate analyses of mastectomy and breast-conserving
surgery were performed. Results. Age was negatively associated with post-surgical treatment, with patients who had
breast-conserving surgery and who were older than 80 years significantly less likely
to undergo radiation therapy (adjusted odds ratio = 0.08 [0.04, 0.14]) or appropriate
adjuvant therapies (adjusted odds ratio = 0.14 [0.08, 0.22]) or both relative to 70-
to 79-year-old patients. This effect did not improve post-intervention. While there
was much variability in compliance with guidelines, surgeons' characteristics did
not explain this variation. Conclusions. In Rhode Island, advanced age continues to be associated with less than adequate
breast cancer therapy. Providing surgeons with “feedback” on the appropriateness of
adjuvant treatment for older patients was insufficient to alter established practices.
Using guideline compliance data as standard “quality indicators” of physician practice
may be required. (Surgery 2000;128:847-61.)
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Article info
Publication history
Accepted:
March 24,
2000
Footnotes
*Funded by the National Cancer Institute (NCI #CA57750).
**An earlier version of this research was presented at The IV International Conference on Geriatric Oncology: Cancer in the Elderly in Rome, Italy, in 1998. A long abstract was published after the conference: Mor V, Laliberte L, Petrisek A, Intrator O, Wachtel T, Bland K. Breast cancer control as quality assurance: results of a hospital-based intervention. Ann Oncol 1998;9:41-3.
★Reprint requests: Vincent Mor, PhD, Center for Gerontology and Health Care Research, Box G-B213, Brown University, Providence, RI 02912.
★★Surgery 2000;128:847-61.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
