(HealthDay News) — Fewer than half of women with localized breast cancer for whom adjuvant chemotherapy is discretionary, either due to clinical factors or age, tend to utilize adjuvant chemotherapy; however, when clinically indicated, women initiate chemotherapy at a high rate, according to research published online Sept. 24 in the Journal of Clinical Oncology.

In a prospective cohort study involving 1,145 women with nonmetastatic breast cancer, Alfred I. Neugut, M.D., Ph.D., of the Columbia University Medical Center in New York City, and colleagues examined the medical and nonmedical factors that influence patient and physician decisions regarding adjuvant chemotherapy.

Chemotherapy was indicated for 34.2 percent of patients; clinically discretionary for 40.1 percent; discretionary based on patient age for 14.8 percent; and was not indicated for 10.9 percent of patients. The researchers found that 90 percent of patients for whom chemotherapy was indicated received it, compared with only 36 percent of those for whom it was discretionary due to clinical factors, and 19 percent for those for whom it was discretionary due to patient age. Patients who did not receive chemotherapy tended to be older with more negative beliefs about treatment efficacy, less positive beliefs relating to chemotherapy, and greater concern regarding adverse events. Clinical predictors of worse outcome correlated with increased chemotherapy initiation among patients for whom chemotherapy was discretionary.

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“Women for whom adjuvant chemotherapy is definitively recommended generally initiate chemotherapy at a high rate. Among patients for whom it was discretionary, less than half received chemotherapy,” the authors write. “As would be expected, younger age and worse prognostic features are associated with increased rates of chemotherapy initiation in these discretionary groups.”


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