Treatment for Breast Cancer in Patients with Alzheimer's Disease

Abstract

Objectives: To report use of breast cancer treatment (surgery, radiation, and chemotherapy) by patients with Alzheimer's disease (AD). Design: Retrospective cohort study. Setting: Surveillance, Epidemiology, and End Results (SEER) is a population-based cancer registry covering 14% of the U.S. population. Participants: Fifty thousand four hundred sixty breast cancer patients aged 65 and older, of whom 1,935 (3.8%) had a diagnosis of AD before or up to 6 months after cancer diagnosis. Measurements: Diagnosis of AD was taken from International Classification of Diseases, Ninth Revision, diagnostic codes accompanying Medicare billing claims between 1992 and 1999. The SEER program reported surgery and radiation. Chemotherapy was taken from Medicare billing records. Results: Subjects with AD were diagnosed with breast cancer at later stages, when tumors were larger and the likelihood of lymph node involvement had increased. Patients with AD had a lower likelihood of surgery (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.46–0.81), radiation (OR=0.31, 95% CI=0.23–0.41), and chemotherapy (OR=0.44, 95% CI=0.34–0.58) than those without AD. Conclusion: Overall, AD patients receive less treatment for breast cancer than do comparable female Medicare beneficiaries. Chemotherapy and radiation are administered less frequently to women with AD than to other comparable patients. It is unclear whether suboptimal medical care has an effect on their survival. Further research on the effect of screening and treatment decision-making for these patients is warranted.