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Recommendations for appropriate adjuvant therapy in patients with early stage breast cancer decrease substantially when patients reach 70 years of age, according to research published in the International Journal of Radiation Oncology, Biology, Physics.
The study suggests many oncologists may be making treatment decisions based on a 70-year age cutoff, as oncologists were less likely to recommend adjuvant radiation therapy (RT) or endocrine therapy (ET) when patients reached 70 years of age.
This study included data from 2 cohorts of patients enrolled in the National Cancer Database who underwent lumpectomy for early stage breast cancer. Cohort 1 consisted of 160,990 patients with higher-risk features who were eligible for adjuvant RT, and cohort 2 consisted of 394,946 patients who were eligible for adjuvant ET.
In cohort 1, age at diagnosis was significantly associated with receiving a recommendation for adjuvant RT in a multivariate analysis (odds ratio [OR], 0.97 per year; 95% CI, 0.96-0.97; P <.001).
The recommendation for adjuvant RT in cohort 1 decreased from 91.0% when patients were 50-59 years of age, to 90.9% at 60-69 years, and to 78.6% at 70-80 years.
When the researchers assessed each year-over-year age difference, age difference was only associated with adjuvant RT recommendation at 70 years vs 69 years (OR, 0.47; 95% CI, 0.39-0.57; P <.001).
In cohort 2, age at diagnosis was significantly associated with receiving a recommendation of adjuvant ET in a multivariate analysis (OR, 0.99 per year; 95% CI, 0.99-0.99; P <.001).
The recommendation for adjuvant ET in cohort 2 increased from 92.6% when patients were 50-59 years of age to 92.9% at 60-69 years, then decreased to 90.7% at 70-80 years.
When the researchers assessed each year-over-year age difference, age difference was only associated with a significant difference in adjuvant ET recommendation at 70 years vs 69 years (OR, 0.86; 95% CI, 0.74-0.99; P =.001).
“This study suggests that physicians may be vulnerable to the use of an age cutoff heuristic in adjuvant therapy recommendations following BCS [breast-conserving surgery] for early stage breast cancer,” the researchers wrote. “We observed differences in treatment allocation due to this age cutoff heuristic likely to be clinically meaningful.”
The researchers recommended that “physicians should be aware of this bias and make efforts to both incorporate estimated physiologic age and also interpret chronologic age as a continuous variable when assessing patients.”
Reference
Talcott WJ, Cain DM, Yang D, et al. Aging a decade in a day: Age cutoff bias in adjuvant therapy allocation for early-stage breast cancer. Int J Rad Oncol Biol Physics. Published online January 31, 2023. doi:10.1016/j.ijrobp.2022.12.057
This article originally appeared on Cancer Therapy Advisor
