Elderly women more likely to have chemotherapy for breast cancer in private clinics

An elderly woman with breast cancer was more likely to undergo chemotherapy if her oncologist was in private practice, according to researchers at Columbia University.

Hershman et al reviewed data from the SEER database on 42,544 women with stage I-III breast cancer who were aged 65 years or older. All women in the cohort were diagnosed from 1991 to 2002.

The researchers found that 8,714 women (20%) were treated with chemotherapy. They determined that women treated by an oncologist in private practice underwent chemotherapy more often than patients treated in a non-private setting (OR=1.40; 95% CI, 1.23-1.60). Hershman et al said the association between private practice and chemotherapy use was similar for patients who were at both high risk (OR=1.55) and low risk for recurrence (OR=1.35).

Similarly, oncologists who graduated after 1975 were more likely to assign their patients to chemotherapy (OR=1.12; 95% CI, 1.01-1.26). In contrast, elderly women treated by U.S.-trained oncologists were less likely to undergo chemotherapy (OR=0.83; 95% CI, 0.74-0.93).

Hershman et al listed possible explanations for the findings, suggesting that private practitioners might see more patients and so might be more comfortable assigning elderly patients to chemotherapy. They also considered the possibility that some oncologists might have a profit motive in ordering chemotherapy but said more research was needed to determine the reasons behind the results.

Hershman DL. Cancer. 2009;doi:10.1002/cncr.24448.