Fax: (617) 638-8312
Predictors and outcomes of surgeons' referral of older breast cancer patients to medical oncologists
Version of Record online: 28 JUN 2005
Copyright © 2005 American Cancer Society
Volume 104, Issue 5, pages 936–942, 1 September 2005
How to Cite
Thwin, S. S., Fink, A. K., Lash, T. L. and Silliman, R. A. (2005), Predictors and outcomes of surgeons' referral of older breast cancer patients to medical oncologists. Cancer, 104: 936–942. doi: 10.1002/cncr.21256
- Issue online: 17 AUG 2005
- Version of Record online: 28 JUN 2005
- Manuscript Accepted: 4 MAY 2005
- Manuscript Received: 29 MAR 2005
- National Cancer Institute. Grant Number: R01 CA/AG70818
- National Institute on Aging. Grant Numbers: K05 CA92395, K07 CA87724
- National Cancer Institute. Grant Number: R01 CA84506
- breast cancer;
- physician referral;
- quality of care
Older women are less likely than younger women to receive definitive care for a new diagnosis of breast cancer, but the reasons are not well understood. Although coordination of referral among specialists is an important component of quality of care, it has not been studied as a factor that contributes to observed age-related variations in breast cancer care.
Treatment recommendations by 191 surgeons of 559 patients aged ≥ 65 years with Stage I to IIIa breast cancer provided patient-specific assessments of comorbidity and medical oncologist referral. Demographic, tumor, and treatment characteristics from medical records and telephone interviews were evaluated by statistical regression methods to identify factors associated with referral to a medical oncologist and to evaluate whether a referral resulted in discussion and prescription of tamoxifen.
Estrogen receptor protein negativity and higher tumor stage increased the likelihood of referral (odds ratio [OR] = 5.6, 95% confidence interval [CI] = 1.9–16.7, and OR = 4.2, 95% CI = 1.7–10.3, respectively), whereas a moderate to severely ill health status decreased the likelihood of referral (OR = 0.4, 95% CI = 0.2–0.9). Those referred were twice as likely to report having a discussion about tamoxifen (OR = 2.0, 95% CI = 1.06–3.7) and to have been prescribed tamoxifen (OR = 2.1, 95% CI = 0.99–4.3).
Referral to medical oncologists is associated with receipt of adjuvant tamoxifen therapy. The current study findings suggest that more consistent referral of older women to medical oncologists may enhance quality of discussion and participation in decisions concerning treatment options. Cancer 2005. © 2005 American Cancer Society.