Older women with local or regional state breast cancer are less likely to receive definitive treatment than are younger women. Among women over age 65, we have identified a number of factors in addition to advanced age that are independently associated with increased risk for non-treatment or less than definitive treatment. These include decreased social support, poor access to transportation, impaired cognition, and minority race. In our analyses these factors have a much stronger effect than does comorbidity on choice of treatment. In addition, we have found large differences between different states and between different hospitals in a given state in the percent of older women with local breast cancer who undergo breast conserving surgery. Most women aged 65 or over who receive breast conserving surgery do not receive adjuvant radiotherapy. We now wish to test whether an intervention combining some of the roles of an oncology nurse with a geriatric case manager will favorably influence the treatment of older breast cancer patients at community hospitals. All women aged 65 or older newly diagnosed with breast cancer at eight South Texas hospitals will be interviewed and their charts reviewed to find out about characteristics that we have previously shown to predict treatment choice. The women receiving the intervention will be assigned an oncology nurse case manager, who will provide education, counseling, and help in arranging support services (transportation, enlisting family support, etc.). The intervention will occur at four hospitals for one year, with four matched hospitals serving as controls, then with a crossover of the intervention and control hospitals for the next year. We hypothesize that a higher percentage of women with local or regional disease in the intervention group will receive conservative surgery, that a higher percentage of women who receive conservative surgery will receive adjuvant radiotherapy, that a higher percentage will receive hormonal therapy, that quality of life measurements at one, six and twelve months post diagnosis will be higher in the intervention group, and that the percentage of patients in the intervention group that receive what is considered "usually appropriate" therapy will be higher than in the control group.
NIH ExPorter
NIH ExPorter