This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Sheldon Greenfield, MD; Dolores M. Blanco, MPH; Robert M. Elashoff, PhD; Patricia A. Ganz, MD

JAMA. 1987;257(20):2766-2770.

Abstract
We performed a chart review study to determine whether physicians provided less vigorous treatment for elderly patients with breast cancer than for younger patients. Seven hospitals, varying with respect to size, medical school affiliation, and patient socioeconomic status participated in this study. Patterns of breast cancer care were compared with a set of branching logic standards in the form of a criteria map. A chart-based comorbidity index was developed to control for the influence of coexisting diseases on cancer management. Logistic regression analysis of 374 breast cancer cases revealed that both patient age and comorbidity status significantly and independently affected treatment. Among stage I and II patients with no or very mild comorbid disease, 96% of those aged 50 to 69 years received appropriate surgery vs 83% of patients aged 70 years and older. We conclude that physicians may manage patients with this highly treatable disease according to chronologic age without regard for physiological condition and that this age bias may result in a less favorable prognosis than could be achieved using currently recommended therapy.

(JAMA 1987;257:2766-2770)

Author Affiliations
From the Departments of Medicine (Drs Greenfield and Ganz and Ms Blanco) and Biomathematics (Dr Elashoff), UCLA, Los Angeles; and the Department of Medicine, Veterans Administration Hospital, Sepulveda, Calif (Dr Ganz).

Footnotes
Reprint requests to the Department of Medicine, UCLA School of Medicine, 42-170 CHS, Los Angeles, CA 90024 (Dr Greenfield).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evaluation of the clinimetric properties of the Early Inflammatory Arthritis--self-administered comorbidity questionnaire
Baron et al.
Rheumatology (Oxford) 2009;48:390-394.
ABSTRACT | FULL TEXT  

Use of Intravenous Bisphosphonates in Older Women with Breast Cancer
Giordano et al.
The Oncologist 2008;13:494-502.
ABSTRACT | FULL TEXT  

The Diabetic Person Beyond a Foot Ulcer: Healing, Recurrence, and Depressive Symptoms
Monami et al.
J. Am. Podiatr. Med. Assoc. 2008;98:130-136.
ABSTRACT | FULL TEXT  

Melanoma in Older Patients
Lange and Balch
Am Soc Clin Oncol Ed Book 2008;2008:399-402.
ABSTRACT | FULL TEXT  

Desire for Information and Involvement in Treatment Decisions: Elderly Cancer Patients' Preferences and Their Physicians' Perceptions
Elkin et al.
JCO 2007;25:5275-5280.
ABSTRACT | FULL TEXT  

Could geriatric comprehensive assessment predict the outcome of pneumonia in the very old?
Pepersack and de Breucker
Age Ageing 2007;36:455-459.
FULL TEXT  

Methodology, Design, and Analytic Techniques to Address Measurement of Comorbid Disease
Lash et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2007;62:281-285.
ABSTRACT | FULL TEXT  

Impact of a scientific presentation on community treatment patterns for primary breast cancer.
Giordano et al.
JNCI J Natl Cancer Inst 2006;98:382-388.
ABSTRACT | FULL TEXT  

Breast Cancer Treatment Guidelines in Older Women
Giordano et al.
JCO 2005;23:783-791.
ABSTRACT | FULL TEXT  

Prevalence and Determinants of Impaired Glucose Metabolism in Frail Elderly Patients: The Belgian Elderly Diabetes Survey (BEDS)
Hermans et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2005;60:241-247.
ABSTRACT | FULL TEXT  

Compliance With Consensus Recommendations for Systemic Therapy Is Associated With Improved Survival of Women With Node-Negative Breast Cancer
Hebert-Croteau et al.
JCO 2004;22:3685-3693.
ABSTRACT | FULL TEXT  

Age-Related Disparities in Cancer Screening: Analysis of 2001 Behavioral Risk Factor Surveillance System Data
Jerant et al.
Ann Fam Med 2004;2:481-487.
ABSTRACT | FULL TEXT  

Old or Frail: What Tells Us More?
Schuurmans et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2004;59:M962-M965.
ABSTRACT | FULL TEXT  

Symptom Management in the Elderly Cancer Patient: Fatigue, Pain, and Depression
Rao and Cohen
J Natl Cancer Inst Monogr 2004;2004:150-157.
ABSTRACT | FULL TEXT  

Too Old to Care?
Penson et al.
The Oncologist 2004;9:343-352.
ABSTRACT | FULL TEXT  

The Cost-Effectiveness of Screening Mammography beyond Age 65 Years: A Systematic Review for the U.S. Preventive Services Task Force
Mandelblatt et al.
ANN INTERN MED 2003;139:835-842.
ABSTRACT | FULL TEXT  

What Constitutes Optimal Care for Older Women With Breast Cancer?
Silliman
JCO 2003;21:3554-3556.
FULL TEXT  

Multiple Informants: A New Method to Assess Breast Cancer Patients' Comorbidity
Lash et al.
Am J Epidemiol 2003;157:249-257.
ABSTRACT | FULL TEXT  

Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer
Du et al.
ANN INTERN MED 2003;138:90-97.
ABSTRACT | FULL TEXT  

Population-Based Assessment of Hospitalizations for Toxicity From Chemotherapy in Older Women With Breast Cancer
Du et al.
JCO 2002;20:4636-4642.
ABSTRACT | FULL TEXT  

The gifts reserved for age
Evans
Int J Epidemiol 2002;31:792-795.
FULL TEXT  

Use of Adjuvant Chemotherapy and Radiation Therapy for Rectal Cancer Among the Elderly: A Population-Based Study
Neugut et al.
JCO 2002;20:2643-2650.
ABSTRACT | FULL TEXT  

Adjuvant Tamoxifen Prescription in Women 65 Years and Older With Primary Breast Cancer
Silliman et al.
JCO 2002;20:2680-2688.
ABSTRACT | FULL TEXT  

Treatment Decision Making in Early-Stage Breast Cancer: Should Surgeons Match Patients' Desired Level of Involvement?
Keating et al.
JCO 2002;20:1473-1479.
ABSTRACT | FULL TEXT  

Survival Associated with 5-Fluorouracil-Based Adjuvant Chemotherapy among Elderly Patients with Node-Positive Colon Cancer
Sundararajan et al.
ANN INTERN MED 2002;136:349-357.
ABSTRACT | FULL TEXT  

Variations in the Use of Chemotherapy for Elderly Patients With Advanced Ovarian Cancer: A Population-Based Study
Sundararajan et al.
JCO 2002;20:173-178.
ABSTRACT | FULL TEXT  

A Pooled Analysis of Adjuvant Chemotherapy for Resected Colon Cancer in Elderly Patients
Sargent et al.
NEJM 2001;345:1091-1097.
ABSTRACT | FULL TEXT  

Who Gets Adjuvant Treatment for Stage II and III Rectal Cancer? Insight From Surveillance, Epidemiology, and End Results-Medicare
Schrag et al.
JCO 2001;19:3712-3718.
ABSTRACT | FULL TEXT  

Age and Adjuvant Chemotherapy Use After Surgery for Stage III Colon Cancer
Schrag et al.
JNCI J Natl Cancer Inst 2001;93:850-857.
ABSTRACT | FULL TEXT  

Impact of Patient and Provider Characteristics on the Treatment and Outcomes of Colorectal Cancer
Hodgson et al.
JNCI J Natl Cancer Inst 2001;93:501-515.
ABSTRACT | FULL TEXT  

Cost Comparison of Mastectomy Versus Breast-Conserving Therapy for Early-Stage Breast Cancer
Barlow et al.
JNCI J Natl Cancer Inst 2001;93:447-455.
ABSTRACT | FULL TEXT  

Effect of Age and Comorbidity in Postmenopausal Breast Cancer Patients Aged 55 Years and Older
Yancik et al.
JAMA 2001;285:885-892.
ABSTRACT | FULL TEXT  

Physician Sex and Other Factors Associated With Type of Breast Cancer Surgery in Older Women
Cyran et al.
Arch Surg 2001;136:185-191.
ABSTRACT | FULL TEXT  

Adjuvant Tamoxifen: Predictors of Use, Side Effects, and Discontinuation in Older Women
Demissie et al.
JCO 2001;19:322-328.
ABSTRACT | FULL TEXT  

Older Age, Aggressiveness of Care, and Survival for Seriously Ill, Hospitalized Adults
Hamel et al.
ANN INTERN MED 1999;131:721-728.
ABSTRACT | FULL TEXT  

Proposed Agenda for the Measurement of Quality-of-Care Outcomes in Oncology Practice
Mandelblatt et al.
JCO 1999;17:2614-2614.
ABSTRACT | FULL TEXT  

Patient Age and Decisions To Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults
Hamel et al.
ANN INTERN MED 1999;130:116-125.
ABSTRACT | FULL TEXT  

Importance of Functional Measures in Predicting Mortality Among Older Hospitalized Patients
Inouye et al.
JAMA 1998;279:1187-1193.
ABSTRACT | FULL TEXT  

Bibliography
Current Sociology 1998;46:128-144.
 

Primary Care Physician Recommendations for Colorectal Cancer Screening: Patient and Practitioner Factors
Cooper et al.
Arch Intern Med 1997;157:1946-1950.
ABSTRACT  

Variation in the Use of Do-Not-Resuscitate Orders in Patients With Stroke
Shepardson et al.
Arch Intern Med 1997;157:1841-1847.
ABSTRACT  

Communication of Preferences for Care Among Human Immunodeficiency Virus--Infected Patients: Barriers to Informed Decisions?
Mouton et al.
Arch Fam Med 1997;6:342-347.
ABSTRACT  

The Influences of Patient Characteristics and Physician Experience on Case Recall
Durante et al.
Med Decis Making 1997;17:199-207.
ABSTRACT  

Angina Patients' Ratings of Current Health and Health without Angina: Associations with Severity of Angina and Comorbidity
Chen et al.
Med Decis Making 1996;16:169-177.
ABSTRACT  

Doxorubicin-Based Chemotherapy in Elderly Patients With Metastatic Breast Cancer: Tolerance and Outcome
Ibrahim et al.
Arch Intern Med 1996;156:882-888.
ABSTRACT  

Older Persons 'Medical Encounters and their Outcomes
Beisecker
Research on Aging 1996;18:9-31.
ABSTRACT  

The Effect of Age and Comorbidity in the Treatment of Elderly Women With Nonmetastatic Breast Cancer
Newschaffer et al.
Arch Intern Med 1996;156:85-90.
ABSTRACT  

A population-based study of the coverage of cancer patients by hospice services
Hunt and McCaul
Palliat Med 1996;10:5-12.
ABSTRACT  

The Importance of Physician Communication on Breast Cancer Screening of Older Women
Fox et al.
Arch Intern Med 1994;154:2058-2068.
ABSTRACT  

Age Does Not Predict Breast Cancer Outcome
Crowe et al.
Arch Surg 1994;129:483-488.
ABSTRACT  

Pain and Its Treatment in Outpatients with Metastatic Cancer
Cleeland et al.
NEJM 1994;330:592-596.
ABSTRACT | FULL TEXT  

Practice Variation in the Management of Pharyngitis: The Importance of Variability in Patients' Clinical Characteristics and in Physicians' Responses to Them
Poses et al.
Med Decis Making 1993;13:293-301.
ABSTRACT  

Age Differences in the Breast Cancer Management of Rural Women
Howe et al.
J Aging Health 1993;5:402-416.
ABSTRACT  

Socioeconomic Status and Risk for Substandard Medical Care
Burstin et al.
JAMA 1992;268:2383-2387.
ABSTRACT  

Chemotherapy of Metastatic Breast Cancer in the Elderly: The Piedmont Oncology Association Experience
Christman et al.
JAMA 1992;268:57-62.
ABSTRACT  

Breast Cancer Screening for Elderly Women with and without Comorbid Conditions: A Decision Analysis Model
Mandelblatt et al.
ANN INTERN MED 1992;116:722-730.
ABSTRACT  

Comorbidities, Complications, and Coding Bias: Does the Number of Diagnosis Codes Matter in Predicting In-Hospital Mortality?
lezzoni et al.
JAMA 1992;267:2197-2203.
ABSTRACT  

Differences in the Mix of Patients Among Medical Specialties and Systems of Care: Results From the Medical Outcomes Study
Kravitz et al.
JAMA 1992;267:1617-1623.
ABSTRACT  

Risk Factors for Delirium in Hospitalized Elderly
Schor et al.
JAMA 1992;267:827-831.
ABSTRACT  

Delirium: The Occurrence and Persistence of Symptoms Among Elderly Hospitalized Patients
Levkoff et al.
Arch Intern Med 1992;152:334-340.
ABSTRACT  

Hospital Variables Associated With Quality of Care for Breast Cancer Patients
Hand et al.
JAMA 1991;266:3429-3432.
ABSTRACT  

Variations in Length of Stay and Outcomes for Six Medical and Surgical Conditions in Massachusetts and California
Cleary et al.
JAMA 1991;266:73-79.
ABSTRACT  

The Ambiguous Relation between Aging and Adverse Drug Reactions
Gurwitz and Avorn
ANN INTERN MED 1991;114:956-966.
ABSTRACT  

Implications of Health Status in Analysis of Risk in Older Persons
Harris and Feldman
J Aging Health 1991;3:262-284.
ABSTRACT  

A Population-Based Study of Functional Status and Social Support Networks of Elderly Patients Newly Diagnosed With Cancer
Goodwin et al.
Arch Intern Med 1991;151:366-370.
ABSTRACT  

The Influence of Patient Age on the Diagnosis and Treatment of Lung and Colorectal Cancer
Guadagnoli et al.
Arch Intern Med 1990;150:1485-1490.
ABSTRACT  

Factors Associated With the Recommendation for Endocarditis Prophylaxis in Mitral Valve Prolapse
Lavie et al.
JAMA 1989;262:3308-3312.
ABSTRACT  

Differential Health Screening of the Well Elderly by Gender and Age: Appropriate Care or Bias?
Lubben et al.
Journal of Applied Gerontology 1989;8:335-354.
ABSTRACT  

Social Concerns of Post-Mastectomy Women: Stigmata and Clothing
Feather et al.
Family and Consumer Sciences Research Journal 1989;17:289-299.
ABSTRACT  

Geriatrics
Cohen and Lyles
JAMA 1989;261:2847-2848.
ABSTRACT  

Clinical Decision Making in the Care of the Aged
Levkoff and Wetle
J Aging Health 1989;1:83-101.
ABSTRACT  

Flaws in Mortality Data: The Hazards of Ignoring Comorbid Disease
Greenfield et al.
JAMA 1988;260:2253-2255.
ABSTRACT  

Cancer Treatment Protocols: Who Gets Chosen?
Goodwin et al.
Arch Intern Med 1988;148:2258-2260.
ABSTRACT  

Age as a Factor in Treatment of Colorectal Cancer
Cummings et al.
JAMA 1988;260:924-925.
ABSTRACT  

Changing Treatment of Breast Cancer in New Mexico From 1969 Through 1985
Mann et al.
JAMA 1988;259:3413-3417.
ABSTRACT  

Progress and Objectives in Cancer Control
Breslow and Cumberland
JAMA 1988;259:1690-1694.
ABSTRACT  

Age-Related Breast Cancer Therapy
Shocket
JAMA 1987;258:2526-2526.
ABSTRACT  

Age as a Risk Factor for Inadequate Treatment
Wetle
JAMA 1987;258:516-516.
ABSTRACT