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Biomedical subjects

Aliza K Fink

Publications and source records attributed to Aliza K Fink.

9 recordsLinked to original sources
PubMed2006

Adherence to tamoxifen over the five-year course.

PURPOSE: To estimate the proportion of older women who fail to complete 5 years of tamoxifen therapy and to identify predictors of non-adherence. PATIENTS AND METHODS: We followed 462 women 65-years-old or older with stage I-IIIA breast cancer diagnosed in four US regions between 1996 and 1999 and who initiated tamoxifen therapy. We interviewed patients annually to assess tamoxifen adherence and collected information about predictors of adherence by medical record review, patient interview, and physician questionnaire. RESULTS: Thirty-one percent of patients who started tamoxifen failed to complete the recommended 5-year course. Patients who had initial severe side effects [hazard ratio (HR) per side effect=1.2, 95% confidence interval (CI) 0.97, 1.5] or developed them (HR per new side effect=1.3, 95% CI 1.0, 1.6) were more likely to discontinue. Patients with more prescription medications at baseline were less likely to discontinue (HR per baseline prescription equaled 0.90, 95% CI 0.81, 0.99), whereas patients who added a prescription were more likely to discontinue (HR per new prescription equaled 1.2, 95% CI 1.0, 1.4). Patients with positive views of tamoxifen at baseline (HR for a 10-point higher score=0.93, 95% CI 0.83, 1.0) and an improving view over follow-up (HR for a 10-point positive change=0.93, 95% CI 0.87, 1.0) were less likely to discontinue. CONCLUSION: Five years of tamoxifen confers a significant benefit beyond 1-2 years of tamoxifen, so physicians should ask patients about side effects, other prescriptions, and beliefs about tamoxifen and should educate them about the benefits of completing adjuvant therapy.

Aged↗
PubMed2005

Predictors and outcomes of surgeons' referral of older breast cancer patients to medical oncologists.

BACKGROUND: Older women are less likely than younger women to receive definitive care for a new diagnosis of breast cancer, but the reasons are not well understood. Although coordination of referral among specialists is an important component of quality of care, it has not been studied as a factor that contributes to observed age-related variations in breast cancer care. METHODS: Treatment recommendations by 191 surgeons of 559 patients aged > or = 65 years with Stage I to IIIa breast cancer provided patient-specific assessments of comorbidity and medical oncologist referral. Demographic, tumor, and treatment characteristics from medical records and telephone interviews were evaluated by statistical regression methods to identify factors associated with referral to a medical oncologist and to evaluate whether a referral resulted in discussion and prescription of tamoxifen. RESULTS: Estrogen receptor protein negativity and higher tumor stage increased the likelihood of referral (odds ratio [OR] = 5.6, 95% confidence interval [CI] = 1.9-16.7, and OR = 4.2, 95% CI = 1.7-10.3, respectively), whereas a moderate to severely ill health status decreased the likelihood of referral (OR = 0.4, 95% CI = 0.2-0.9). Those referred were twice as likely to report having a discussion about tamoxifen (OR = 2.0, 95% CI = 1.06-3.7) and to have been prescribed tamoxifen (OR = 2.1, 95% CI = 0.99-4.3). CONCLUSIONS: Referral to medical oncologists is associated with receipt of adjuvant tamoxifen therapy. The current study findings suggest that more consistent referral of older women to medical oncologists may enhance quality of discussion and participation in decisions concerning treatment options.

Age Factors↗
PubMed2004

Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor--positive breast cancer.

PURPOSE: To investigate the patterns and predictors of tamoxifen discontinuance throughout a 2-year period in a cohort of women 65 years or older with newly diagnosed, estrogen receptor (ER)-positive breast cancer, focusing on the role of patients' beliefs about the risks and benefits of tamoxifen therapy. SUBJECTS AND METHODS: We enrolled a convenience sample of women cared for in four geographic regions of the United States with stage 1 (>/= 1 cm), stage II, or stage IIIA disease; no prior history of breast cancer; and no simultaneously diagnosed second primary breast cancer. Data sources included medical records and telephone interviews with patients at 3, 6, 15, and 27 months following definitive surgery. RESULTS: Of the 597 women with ER-positive tumors, 516 women (86%) were prescribed tamoxifen, and of these, 88 (17%) stopped taking tamoxifen during the 2-year follow-up period. Of the women who stopped taking tamoxifen, the majority (68%) took it for less than 1 year. Women with neutral or negative beliefs about the value of tamoxifen (3.0; 95% CI, 1.6 to 5.6) and those with positive nodes (odds ratio = 2.5; 95% CI, 1.0 to 6.3) were more likely to discontinue tamoxifen therapy. CONCLUSION: How women with early-stage breast cancer perceive the risks and benefits of tamoxifen therapy seems critical for sustaining adherence to adjuvant tamoxifen therapy. Interventions designed to educate women about the benefits and risks of tamoxifen therapy may help to reduce discontinuance.

Age Factors↗
PubMed2004

Null association between pregnancy termination and breast cancer in a registry-based study of parous women.

Studies suggesting a positive association between pregnancy termination and breast cancer risk have often been of retrospective case-control design, so subject to selection and recall biases. We undertook a registry-based analysis with minimal selection bias and prospective record-based ascertainment of terminations. The source population comprised Massachusetts women with a record of giving birth between 1987 and 1999 in the Massachusetts Vital Statistics Registry. Primary breast cancer cases were 25-55 years old at diagnosis between 1988 and 2000 and had a record of the diagnosis in the Massachusetts Cancer Registry. We matched 3 controls to each case on maternal age, year of giving birth and birth facility. Information on terminations (induced and spontaneous) before the birth of record, the matched factors and potential confounders were collected from the birth certificate. After adjustment for the matched factors, age, parity and maternal and paternal education, the odds ratio associating any termination history with breast cancer risk equaled 0.91 (95% CI = 0.79-1.05). The marginally protective adjusted odds ratio largely derived from a protective effect among women with parity equaled to 1 (OR for any termination = 0.68; 95% CI = 0.45-1.03), suggesting a protective effect of terminated pregnancy among women with one live birth.

Abortion, Induced↗
PubMed2004

The relationship among physicians' specialty, perceptions of the risks and benefits of adjuvant tamoxifen therapy, and its recommendation in older patients with breast cancer.

OBJECTIVES: The objectives of this study were to determine whether tamoxifen recommendation differs by physician specialty, to determine whether perception affects tamoxifen recommendation, and to investigate the association between the physician's specialty and the perception of risks and benefits of tamoxifen. METHODS: We enrolled a cohort of geographically diverse women aged 65 and older with stage I through IIIa breast cancer in a prospective cohort study. We recruited their surgeons and, when applicable, their medical oncologists to provide patient-specific information about their perceptions of the risks and benefits of tamoxifen and whether they recommended tamoxifen. Each physician also completed a questionnaire regarding his or her demographic and practice characteristics. Patient data were collected through medical record review and a patient interview 3 months after definitive breast cancer surgery. RESULTS: We collected physician treatment recommendation forms for 585 women. Oncologists were 2.5 times more likely to recommend tamoxifen, compared with surgeons, after adjusting for patient and tumor characteristics (95% confidence interval, 1.5-4.2). For both specialties, their perceptions of the risks and benefits of tamoxifen were strong predictors of tamoxifen recommendation. However, there were differences in perception by physician specialty. Distant metastases and tolerance of tamoxifen side effects were more important to oncologists, whereas local recurrence and risk of cataracts were more important to surgeons. CONCLUSION: Physicians' perceptions of the risks and benefits of tamoxifen therapy for older women are important in their decision-making process.

Age Factors↗
PubMed2003

A null association between smoking during pregnancy and breast cancer using Massachusetts registry data (United States).

OBJECTIVE: An earlier investigation reported a five-fold increase in breast cancer risk among women who smoked during pregnancy. Using a similar design, we re-examined this hypothesis. METHODS: The source population comprised Massachusetts residents who gave birth between 1987 and 1999 with a birth record in the Massachusetts Vital Statistics Registry. Cases were diagnosed with breast cancer between 1988 and 2000 at ages 25-55 with a record in the Massachusetts Cancer Registry. Three controls were matched to each case on maternal age, year of giving birth, and birth facility. Information on smoking, the matched factors, and potential confounders were collected from the birth certificate. The data were analyzed using conditional logistic regression. RESULTS: After adjusting for potential confounders, women who smoked during pregnancy did not have an increased risk of breast cancer compared to women who did not smoke during pregnancy (relative risk = 1.0, 95% Confidence interval CI = 0.81-1.2). We observed no dose response relation between number of cigarettes smoked per day during pregnancy and breast cancer risk. There was no evidence that our results were biased by misclassification from women inaccurately reporting their smoking status. CONCLUSION: In contrast to the previous study, we did not observe an increased risk of breast cancer in women who smoked during pregnancy.

Adult↗
PubMed2003

Semi-automated sensitivity analysis to assess systematic errors in observational data.

BACKGROUND: Published epidemiologic research usually provides a quantitative assessment of random error for effect estimates, but no quantitative assessment of systematic error. Sensitivity analysis can provide such an assessment. METHODS: We describe a method to reconstruct epidemiologic data, accounting for biases, and to display the results of repeated reconstructions as an assessment of error. We illustrate with a study of the effect of less-than-definitive therapy on breast cancer mortality. RESULTS: We developed SAS code to reconstruct the data that would have been observed had a set of systematic errors been absent, and to convey the results. After 4,000 reconstructions of the example data, we obtained a median estimate of relative hazard equal to 1.5 with a 95% simulation interval of 0.8-2.8. The relative hazard obtained by conventional analysis equaled 2.0, with a 95% confidence interval of 1.2-3.4. CONCLUSIONS: Our method of sensitivity analysis can be used to quantify the systematic error for an estimate of effect and to describe that error in figures, tables, or text. In the example, the sources of error biased the conventional relative hazard away from the null, and that error was not accurately communicated by the conventional confidence interval.

Bias↗
PubMed2002

Advanced age and adjuvant tamoxifen prescription in early-stage breast carcinoma patients.

BACKGROUND: Adjuvant tamoxifen is recommended for all women with estrogen receptor-positive breast carcinoma without regard for age. We investigated age-dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older. METHODS: We studied 92 women diagnosed at four U.S. sites with primary, early-stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85-92 years of age with those received by women 80-84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed. RESULTS: Before adjustment, patients 85-92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80-84 years of age (RR = 0.72, 95% CI 0.57-0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58-0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59-0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed. CONCLUSION: Given the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality.

Age Factors↗