Age-based heuristics may lead to large differences in breast cancer treatment based on small differences in chronologic age, according to a new study published by Talcott et al in the International Journal of Radiation Oncology • Biology • and Physics.
Background
Radiation therapy often is given after breast-conserving surgery to help prevent a patient’s cancer from returning. While postsurgical radiation may be omitted for certain patients with early-stage breast cancer—including older patients with lower-risk disease—it remains standard for patients with a higher risk of cancer recurrence.
Our findings suggest that cognitive heuristics, or ‘rules of thumb,’ play a greater role in physician decision-making than we previously realized. It’s important that we center individual patients—with the unique characteristics of their cancer as well as their individual preferences—in treatment decisions.— Suzanne B. Evans, MD, MPH, FASTRO
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Study Methods and Findings
In the new study—one of the first to demonstrate an age cutoff heuristic in oncology—investigators analyzed nationwide data from 500,000 patient records and found that patients at a higher risk of cancer recurrence who were aged 70 years at the time of diagnosis may have been nearly twice as likely to be passed over for radiation therapy as those aged 69 years.
The patients diagnosed at age 70 were 53% less likely to be recommended postoperative radiation and 39% less likely to receive it compared to 69-year-old patients. The investigators found no similar gaps between other year-over-year age groups.
Conclusions
“Our findings suggest that cognitive heuristics, or ‘rules of thumb,’ play a greater role in physician decision-making than we previously realized. It’s important that we center individual patients—with the unique characteristics of their cancer as well as their individual preferences—in treatment decisions,” emphasized senior study author Suzanne B. Evans, MD, MPH, FASTRO, Professor of Therapeutic Radiology at the Yale Cancer Center at the Yale School of Medicine.
“While we would expect recommendations for this treatment to decline gradually as expected lifespan shortens, there seems to be a steep cliff when a patient moves from their 60s to their 70s. In breast oncology, physicians seem to anchor on a patient entering their 70s as a signal to de-escalate care, even in situations where evidence does not support this practice,” underscored lead study author Wesley J. Talcott, MD, MBA, Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and a radiation oncologist at Northwell Health. “Our study indicates that physicians should be mindful of how we factor age into treatment decisions and adopt a more nuanced approach, extending beyond defining patients as simply ’young’ or ’elderly,’” he concluded.
Disclosure: For full disclosures of the study authors, visit redjournal.org.
