However, few previous studies had looked at whether doctors are following guidelines for adjuvant therapy. To determine whether the potentially life-saving chemotherapy is actually being given to those older women who should receive it, the researchers examined information on 10,600 women over 65 years of age with a breast cancer diagnosis.

Researchers analyzed Medicare claims to determine when and under what conditions chemotherapy was used. They gathered their information from a large Medicare database that had been merged with the national cancer registry, the SEER database, which represents 14% of the U.S. population in various geographical areas. (SEER stands for Surveillance, Epidemiology and End Results). The SEER information told investigators the stage, size and estrogen receptor status of the breast cancer, and the types of treatment provided within four months after the date of diagnosis. The stage, size and estrogen receptor status of the cancer determines whether a woman will receive chemotherapy.

Herman Kattlove, M.D., medical oncologist and medical editor for the American Cancer Society (ACS), says the findings of this study are valuable. "Used together, the Medicare and SEER databases can act as a report card for measuring the quality of care given to breast cancer patients," he says. "This kind of analysis tells us the whether the patients who should receive adjuvant therapy are actually receiving it."

Most noticeably, he said, the study confirms that most patients aged 65-69 are getting good care. "Seventy percent of women in this age group who should have received chemotherapy did receive it," he said, adding, "This type of study can at least tell us what the normal practice pattern is," Kattlove says.

The study also found that as the women got older, fewer received chemotherapy. In women aged 65 to 69, 49% received chemotherapy, but in women over 80, only 10% received it. But, the authors point out, studies haven't addressed the question of whether women over 70 receive chemotherapy after they have had breast cancer surgery.

One of the study's authors, James S. Goodwin, M.D., chief of the division of geriatrics and internal medicine at the University of Texas Medical Branch at Galveston, believes one advantage of this study is its wide cross-section of people. "The people who participate in most clinical trials do not look like the rest of America," he says. They tend to be better educated and younger and are less likely to have other diseases in addition to cancer, Goodwin says. This study reveals how chemotherapy works "in real populations instead of the more standardized populations that are enrolled in trials," he says.

Research like this can reveal variations in treatment among physicians, hospitals, and regions of the country, Goodwin says. Then the medical community can ask, "Do we need interventions to make a certain treatment more available in a given area?" he says.Confirms Current Standards of Care

The most positive conclusion of the research is that current standards of care for older breast cancer patients are apparently being met. The conclusions reveal appropriate chemotherapy treatments after surgery, matching the results of similar but smaller studies. The data found little variation among ethnic groups.

Because the data come from administrative records rather than actual patient charts, the authors warn that some of the information may be incomplete. For example, if a patient switched her care to an HMO or to a Veterans Affairs hospital, there may be relevant information not in the Medicare claims. Still, the researchers consider the data to be "reasonably accurate and complete."