301
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Zhu W, Perez EA, Hong R, Li Q, Xu B. Age-Related Disparity in Immediate Prognosis of Patients with Triple-Negative Breast Cancer: A Population-Based Study from SEER Cancer Registries. PLoS One 2015; 10:e0128345. [PMID: 26020519 PMCID: PMC4447406 DOI: 10.1371/journal.pone.0128345] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/26/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) has been demonstrated to carry poor prognosis, but whether or not there exists any age-related variation in TNBC outcomes has yet to be elucidated. The current population-based study investigated the early survival pattern of elderly women with TNBC and identified outcome-correlated factors. PATIENTS AND METHODS We searched the Surveillance, Epidemiology, and End Results (SEER) database and enrolled female primary non-metastatic TNBC cases. The patients were subdivided into elderly (≥70 years) and young groups (<70 years). The survival status of elderly patients was compared to that of the younger women. The primary and secondary endpoints were cancer-specific survival (CSS) and overall survival (OS) respectively. RESULTS 9908 female TNBC patients diagnosed from 2010 to 2011 were included in the current study (20.4% elderly). Elderly patients with relatively advanced diseases exhibited distinctly worse cancer-specific (log-rank, p<0.001) and overall survival (log-rank, p<0.001) than their young counterparts. Advanced age at diagnosis (≥70 years) was significantly predictive of poor outcome in terms of CSS (hazard ratio (HR), 2.125; 95% confidence interval (CI), 1.664 to 2.713; p<0.001) and OS (HR, 3.042; 95%CI, 2.474 to 3.740; p<0.001). Underuse of curative treatment especially radiotherapy was more prevalent in elderly women with stage II or III diseases than in younger patients. CONCLUSION Elderly patients with TNBC displayed elevated early mortality within the first two years of diagnosis compared to the younger individuals. The observed lower rate of loco-regional treatment might be associated with worse cancer-specific outcome for these patients.
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Affiliation(s)
- Wenjie Zhu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Edith A. Perez
- Mayo Clinic, Jacksonville, Florida, United States of America
| | - Ruoxi Hong
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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302
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Treatment patterns of elderly breast cancer patients at two Canadian cancer centres. Eur J Surg Oncol 2015; 41:625-34. [DOI: 10.1016/j.ejso.2015.01.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 12/27/2014] [Accepted: 01/11/2015] [Indexed: 11/20/2022] Open
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303
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Cortadellas T, Córdoba O, Gascón A, Haladjian C, Bernabeu A, Alcalde A, Esgueva A, Rodriguez-Revuelto R, Espinosa-Bravo M, Díaz-Botero S, Xercavins J, Rubio I, Gil-Moreno A. Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution. Eur J Surg Oncol 2015; 41:635-40. [DOI: 10.1016/j.ejso.2015.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/18/2014] [Accepted: 01/11/2015] [Indexed: 10/24/2022] Open
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304
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A systematic review and quality appraisal of international guidelines for early breast cancer systemic therapy: Are recommendations sensitive to different global resources? Breast 2015; 24:309-17. [PMID: 25900382 DOI: 10.1016/j.breast.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/19/2014] [Accepted: 12/08/2014] [Indexed: 12/25/2022] Open
Abstract
The breast cancer incidence in low and middle income countries (LMCs) is increasing globally, and patient outcomes are generally worse in these nations compared to high income countries (HICs). This is partly due to resource constraints associated with implementing recommended breast cancer therapies. Clinical practice guideline (CPG) adherence can improve breast cancer outcomes, however, many CPGs are created in HICs, and include costly recommendations that may not be feasible in LMCs. In addition, the quality of CPGs can be variable. The aim of this study was to perform a systematic review of CPGs on early breast cancer systemic therapy with potential international impact, to evaluate their content, quality, and resource sensitivity. A MEDLINE and gray literature search was completed for English language CPGs published between 2005 and 2010, and then updated to July 2014. Extracted guidelines were evaluated using the AGREE 2 instrument. Guidelines were specifically analyzed for resource sensitivity. Most of the extracted CPGs had similar recommendations with regards to systemic therapy. However, only one, the Breast Health Global Initiative, made recommendations with consideration of different global resources. Overall, the CPGs were of variable quality, and most scored poorly in the quality domain evaluating implementation barriers such as resources. Published CPGs for early breast cancer are created in HICs, have similar recommendations, and are generally resource-insensitive. Given the visibility and influence of these CPGs on LMCs, efforts to create higher quality, resource-sensitive guidelines with less redundancy are needed.
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305
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Perrone F, Nuzzo F, Di Rella F, Gravina A, Iodice G, Labonia V, Landi G, Pacilio C, Rossi E, De Laurentiis M, D'Aiuto M, Botti G, Forestieri V, Lauria R, De Placido S, Tinessa V, Daniele B, Gori S, Colantuoni G, Barni S, Riccardi F, De Maio E, Montanino A, Morabito A, Daniele G, Di Maio M, Piccirillo M, Signoriello S, Gallo C, de Matteis A. Weekly docetaxel versus CMF as adjuvant chemotherapy for older women with early breast cancer: final results of the randomized phase III ELDA trial. Ann Oncol 2015; 26:675-682. [DOI: 10.1093/annonc/mdu564] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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306
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Wildiers H, Brain E. Different adjuvant chemotherapy regimens in older breast cancer patients? Ann Oncol 2015; 26:613-615. [DOI: 10.1093/annonc/mdv015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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307
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Lavelle K, Sowerbutts AM, Bundred N, Pilling M, Todd C. Pretreatment health measures and complications after surgical management of elderly women with breast cancer. Br J Surg 2015; 102:653-67. [PMID: 25790147 DOI: 10.1002/bjs.9796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group. METHODS The ability of pretreatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of women aged at least 70 years undergoing surgery for operable (stage I-IIIa) breast cancer at 22 English breast units between 2010 and 2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case-note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery. RESULTS The study included 664 women. One or more complications were experienced by 41·0 per cent of the patients, predominantly seroma or primary/minor infections. Complications were serious in 6·5 per cent. More extensive surgery predicted a higher number of complications, but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariable analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models, pain predicted a higher count of complications (incidence rate ratio 1·01, 95 per cent c.i. 1·00 to 1·01; P = 0·004). Fatigue (odds ratio (OR) 1·02, 95 per cent c.i. 1·01 to 1·03; P = 0·004), low platelet count (OR 4·19, 1·03 to 17·12: P = 0·046) and pulse rate (OR 0·96, 0·93 to 0·99; P = 0·010) predicted serious complications. CONCLUSION The risk of serious complications from breast surgery is low for older patients. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak, with 95 per cent c.i. close to unity.
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Affiliation(s)
- K Lavelle
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Core Technology Facility, Manchester, UK
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308
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Traitements inhibiteurs de la résorption osseuse en situation métastatique : bilan actuel et perspectives. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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309
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Assessing treatment effects in older breast cancer patients: Systematic review of observational research methods. Cancer Treat Rev 2015; 41:254-61. [DOI: 10.1016/j.ctrv.2014.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/29/2014] [Accepted: 12/31/2014] [Indexed: 11/21/2022]
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310
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James R, McCulley SJ, Macmillan RD. Oncoplastic and reconstructive breast surgery in the elderly. Br J Surg 2015; 102:480-8. [DOI: 10.1002/bjs.9733] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/11/2014] [Accepted: 11/03/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The recommendations of the UK All Party Parliamentary Group on Breast Cancer (2013) have been endorsed recently by the UK Association of Breast Surgeons and are in line with the 2007 Cancer Reform Strategy, which states that treatment in older British women should be equivalent to that in younger patients unless precluded by co-morbidity or patient choice. Oncoplastic and reconstructive techniques are increasingly available to women with breast cancer. A review of the literature was carried out to investigate use of these techniques in older patients.
Methods
A MEDLINE search was conducted to identify studies relating to oncoplastic and reconstructive surgery in the elderly.
Results and conclusion
Nine studies were identified and included in the review. Older patients undergoing reconstruction, particularly autologous reconstruction, have outcomes that are at least as good as those achieved in younger patients, yet are far less likely to be offered these techniques. Issues influencing oncoplastic and reconstructive surgery in the elderly include: lack of standard pathways of care, concerns regarding higher operative risk, lack of evidence regarding outcomes, preconceptions regarding body image and lack of engagement with the decision-making process. A minority of older women are likely to accept reconstruction, but those who do are pleased with the results and experience good quality of life. There is now a range of safe oncoplastic and reconstructive options that could be considered as an alternative to standard mastectomy or wide local excision in older patients.
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Affiliation(s)
- R James
- Nottingham Breast Institute, Nottingham, UK
| | - S J McCulley
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, UK
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311
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Kiderlen M, Walsh PM, Bastiaannet E, Kelly MB, Audisio RA, Boelens PG, Brown C, Dekkers OM, de Craen AJM, van de Velde CJH, Liefers GJ. Treatment strategies and survival of older breast cancer patients - an international comparison between the Netherlands and Ireland. PLoS One 2015; 10:e0118074. [PMID: 25646756 PMCID: PMC4315587 DOI: 10.1371/journal.pone.0118074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/04/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Forty percent of breast cancers occur among older patients. Unfortunately, there is a lack of evidence for treatment guidelines for older breast cancer patients. The aim of this study is to compare treatment strategy and relative survival for operable breast cancer in the elderly between The Netherlands and Ireland. MATERIAL AND METHODS From the Dutch and Irish national cancer registries, women aged ≥65 years with non-metastatic breast cancer were included (2001-2009). Proportions of patients receiving guideline-adherent locoregional treatment, endocrine therapy, and chemotherapy were calculated and compared between the countries by stage. Secondly, 5-year relative survival was calculated by stage and compared between countries. RESULTS Overall, 41,055 patients from The Netherlands and 5,826 patients from Ireland were included. Overall, more patients received guideline-adherent locoregional treatment in The Netherlands, overall (80% vs. 68%, adjusted p<0.001), stage I (83% vs. 65%, p<0.001), stage II (80% vs. 74%, p<0.001) and stage III (74% vs. 57%, P<0.001) disease. On the other hand, more systemic treatment was provided in Ireland, where endocrine therapy was prescribed to 92% of hormone receptor-positive patients, compared to 59% in The Netherlands. In The Netherlands, only 6% received chemotherapy, as compared 24% in Ireland. But relative survival was poorer in Ireland (5 years relative survival 89% vs. 83%), especially in stage II (87% vs. 85%) and stage III (61% vs. 58%) patients. CONCLUSION Treatment for older breast cancer patients differed significantly on all treatment modalities between The Netherlands and Ireland. More locoregional treatment was provided in The Netherlands, and more systemic therapy was provided in Ireland. Relative survival for Irish patients was worse than for their Dutch counterparts. This finding should be a strong recommendation to study breast cancer treatment and survival internationally, with the ultimate goal to equalize the survival rates for breast cancer patients across Europe.
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Affiliation(s)
- Mandy Kiderlen
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Dept. of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Esther Bastiaannet
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Dept. of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Riccardo A. Audisio
- Department of Surgery, St Helens Teaching Hospital, St Helens, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Petra G. Boelens
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Chris Brown
- National Cancer Registry of Ireland, Cork, Ireland
| | - Olaf M. Dekkers
- Dept. of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J. M. de Craen
- Dept. of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gerrit-Jan Liefers
- Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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312
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Antoine V, de Wazières B, Houédé N. Attentes des professionnels hospitaliers impliqués dans la prise en charge globale en oncogériatrie. Bull Cancer 2015; 102:150-61. [DOI: 10.1016/j.bulcan.2014.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022]
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313
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Self-detection and clinical breast examination: Comparison of the two “classical” physical examination methods for the diagnosis of breast cancer. Breast 2015; 24:90-2. [DOI: 10.1016/j.breast.2014.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/16/2014] [Indexed: 11/18/2022] Open
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314
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Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 2015; 16:266-73. [PMID: 25637340 DOI: 10.1016/s1470-2045(14)71221-5] [Citation(s) in RCA: 581] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND For most older women with early breast cancer, standard treatment after breast-conserving surgery is adjuvant whole-breast radiotherapy and adjuvant endocrine treatment. We aimed to assess the effect omission of whole-breast radiotherapy would have on local control in older women at low risk of local recurrence at 5 years. METHODS Between April 16, 2003, and Dec 22, 2009, 1326 women aged 65 years or older with early breast cancer judged low-risk (ie, hormone receptor-positive, axillary node-negative, T1-T2 up to 3 cm at the longest dimension, and clear margins; grade 3 tumour histology or lymphovascular invasion, but not both, were permitted), who had had breast-conserving surgery and were receiving adjuvant endocrine treatment, were recruited into a phase 3 randomised controlled trial at 76 centres in four countries. Eligible patients were randomly assigned to either whole-breast radiotherapy (40-50 Gy in 15-25 fractions) or no radiotherapy by computer-generated permuted block randomisation, stratified by centre, with a block size of four. The primary endpoint was ipsilateral breast tumour recurrence. Follow-up continues and will end at the 10-year anniversary of the last randomised patient. Analyses were done by intention to treat. The trial is registered on ISRCTN.com, number ISRCTN95889329. FINDINGS 658 women who had undergone breast-conserving surgery and who were receiving adjuvant endocrine treatment were randomly assigned to receive whole-breast irradiation and 668 were allocated to no further treatment. After median follow-up of 5 years (IQR 3·84-6·05), ipsilateral breast tumour recurrence was 1·3% (95% CI 0·2-2·3; n=5) in women assigned to whole-breast radiotherapy and 4·1% (2·4-5·7; n=26) in those assigned no radiotherapy (p=0·0002). Compared with women allocated to whole-breast radiotherapy, the univariate hazard ratio for ipsilateral breast tumour recurrence in women assigned to no radiotherapy was 5·19 (95% CI 1·99-13·52; p=0·0007). No differences in regional recurrence, distant metastases, contralateral breast cancers, or new breast cancers were noted between groups. 5-year overall survival was 93·9% (95% CI 91·8-96·0) in both groups (p=0·34). 89 women died; eight of 49 patients allocated to no radiotherapy and four of 40 assigned to radiotherapy died from breast cancer. INTERPRETATION Postoperative whole-breast radiotherapy after breast-conserving surgery and adjuvant endocrine treatment resulted in a significant but modest reduction in local recurrence for women aged 65 years or older with early breast cancer 5 years after randomisation. However, the 5-year rate of ipsilateral breast tumour recurrence is probably low enough for omission of radiotherapy to be considered for some patients. FUNDING Chief Scientist Office (Scottish Government), Breast Cancer Institute (Western General Hospital, Edinburgh).
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Affiliation(s)
- Ian H Kunkler
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
| | - Linda J Williams
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Wilma J L Jack
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - David A Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - J Michael Dixon
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
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315
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Le Saux O, Ripamonti B, Bruyas A, Bonin O, Freyer G, Bonnefoy M, Falandry C. Optimal management of breast cancer in the elderly patient: current perspectives. Clin Interv Aging 2015; 10:157-74. [PMID: 25609933 PMCID: PMC4293298 DOI: 10.2147/cia.s50670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.
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Affiliation(s)
- Olivia Le Saux
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Bertrand Ripamonti
- Gynaecology-Obstetrics Department, University Hospital, Saint-Etienne, France
| | - Amandine Bruyas
- Croix Rousse University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | | | - Gilles Freyer
- Medical Oncology Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France ; Lyon University, Lyon, France
| | - Marc Bonnefoy
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Lyon University, Lyon, France ; Geriatric Unit, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
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316
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de Glas NA, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, Liefers GJ, Portielje JEA. Survival of older patients with metastasised breast cancer lags behind despite evolving treatment strategies--a population-based study. Eur J Cancer 2015; 51:310-6. [PMID: 25559617 DOI: 10.1016/j.ejca.2014.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older women are more likely to be diagnosed with primary metastasised breast cancer than their younger counterparts. Evolving treatment strategies of metastasised breast cancer have resulted in improved survival in younger patients, but it remains unclear if this improvement has occurred in older patients as well. The aim of this study was to assess changes in treatment strategies over time in relation to overall and relative survival of older patients compared to younger patients with primary metastasised breast cancer. METHODS All patients with a breast cancer diagnosis and distant metastases at first presentation (stage IV), between 1990 and 2012, were selected from the Netherlands Cancer Registry. Changes in treatment over time per age-group (<65 years, 65-75 years and >75 years) were assessed using logistic regression. Overall survival over time was calculated using Cox Regression Models and relative survival was assessed using the Ederer II method. RESULTS Overall, 14,310 patients were included. Treatment strategies have strongly changed in the past twenty years; especially the use of chemotherapy has increased (P<0.001 in all age-groups). Overall survival of patients <65 has significantly improved (Hazard Ratio (HR) per year 0.98, 95% Confidence Interval (CI) 0.98-0.99, P<0.001), but the survival of older patients has not improved (HR 1.00, 95% CI 0.99-1.01, P=0.86 for patients aged 65-75 and HR 1.00, 95% CI 1.00-1.01, P=0.46 for patients aged >75). Similarly, relative survival has improved in patients <65 but not in women aged 65-75 and >75. CONCLUSION Overall and relative survival of older patients with metastasised breast cancer at first presentation have not improved in recent years in contrast with the survival of younger patients, despite increased treatment with chemotherapy for women of all ages. Future studies should focus on stratification models that can be used to predict which patients may benefit from specific treatment options.
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Affiliation(s)
- N A de Glas
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E Bastiaannet
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - A J M de Craen
- Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - C J H van de Velde
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - S Siesling
- Comprehensive Cancer Centre the Netherlands, Department of Research, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
| | - G J Liefers
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J E A Portielje
- Haga Hospital The Hague, Department of Internal Medicine, Leyweg 275, 2545 CH Den Haag, The Netherlands.
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317
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Abstract
Breast cancer is a disease of aging. The average age at diagnosis is 61, and the majority of deaths occur after age 65. Caring for older women with breast cancer is a major challenge, as many have coexisting illness that can preclude optimal breast cancer treatment and which frequently have greater effect than the breast cancer itself. Older patients with cancer should be screened or have a brief geriatric assessment to detect potentially remediable problems not usually assessed by oncologists (e.g., self-care, falls, social support, nutrition). Older women with early-stage breast cancer should be treated initially with surgery unless they have an exceedingly short life expectancy. Primary endocrine therapy should be considered for patients who have hormone receptor-positive tumors and a very short life expectancy, an acute illness that delays surgery, or tumors that need to be downstaged to be resectable. Sentinel node biopsy should be considered for patients in whom it might affect treatment decisions. Breast irradiation after breast-conserving surgery may be omitted for selected older women, especially for those with hormone receptor-positive early-stage breast cancer that are compliant with adjuvant endocrine therapy. The majority of older women with stage I and II breast cancer have hormone receptor-positive, HER2-negative tumors, and endocrine therapy provides them with optimal systemic treatment. If these patients have life expectancies exceeding at least 5 years, they should be considered for genetic assays to determine the potential value of chemotherapy. Partnering care with geriatricians or primary care physicians trained in geriatrics should be considered for all vulnerable and frail older patients.
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Affiliation(s)
- Rinaa S Punglia
- From Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA; Avon Comprehensive Breast Evaluation Center, Harvard Medical School and Bermuda Cancer Genetics and Risk Assessment Clinic, Massachusetts General Hospital, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin S Hughes
- From Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA; Avon Comprehensive Breast Evaluation Center, Harvard Medical School and Bermuda Cancer Genetics and Risk Assessment Clinic, Massachusetts General Hospital, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hyman B Muss
- From Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA; Avon Comprehensive Breast Evaluation Center, Harvard Medical School and Bermuda Cancer Genetics and Risk Assessment Clinic, Massachusetts General Hospital, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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318
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Histopathological characterization of ulcerated breast cancer and comparison to their non-ulcerated counterparts. Tumour Biol 2014; 36:3423-8. [DOI: 10.1007/s13277-014-2977-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
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319
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Tew WP, Muss HB, Kimmick GG, Von Gruenigen VE, Lichtman SM. Breast and ovarian cancer in the older woman. J Clin Oncol 2014; 32:2553-61. [PMID: 25071129 DOI: 10.1200/jco.2014.55.3073] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.
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Soubeyran P, Bellera C, Goyard J, Heitz D, Curé H, Rousselot H, Albrand G, Servent V, Jean OS, van Praagh I, Kurtz JE, Périn S, Verhaeghe JL, Terret C, Desauw C, Girre V, Mertens C, Mathoulin-Pélissier S, Rainfray M. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One 2014; 9:e115060. [PMID: 25503576 PMCID: PMC4263738 DOI: 10.1371/journal.pone.0115060] [Citation(s) in RCA: 354] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/12/2014] [Indexed: 12/13/2022] Open
Abstract
Background Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13). Patients and Methods The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate. Results Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival. Conclusion With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.
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Affiliation(s)
- Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- University of Bordeaux, Bordeaux, France
- * E-mail:
| | - Carine Bellera
- Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d′investigation clinique), Institut Bergonié, Bordeaux, France
| | - Jean Goyard
- Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France
| | - Damien Heitz
- Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France
| | - Hervé Curé
- Geriatric unit, Institut Jean Godinot, Reims, France
| | - Hubert Rousselot
- Cancer Support unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France
| | - Gilles Albrand
- Geriatric Evaluation and Management unit, Antoine Charial Hospital, Francheville, Lyon, France
| | | | - Olivier Saint Jean
- Internal Medicine unit, Hôpital européen Georges-Pompidou, Paris, France
| | - Isabelle van Praagh
- Oncogeriatric Coordination unit, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jean-Emmanuel Kurtz
- Oncology and Hematology unit, Centre Hospitalier Universitaire de Strasbourg - Hôpital de Hautepierre, Strasbourg, France
| | | | - Jean-Luc Verhaeghe
- Surgical Oncology unit, Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France
| | | | - Christophe Desauw
- Senology unit, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Véronique Girre
- Oncology and Haematology unit, Centre Hospitalier Départemental, La Roche sur Yon, France
| | - Cécile Mertens
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Simone Mathoulin-Pélissier
- University of Bordeaux, Bordeaux, France
- Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France
- INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d′investigation clinique), Institut Bergonié, Bordeaux, France
| | - Muriel Rainfray
- University of Bordeaux, Bordeaux, France
- Department of Clinical Gerontology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Mustacchi G, Scanni A, Capasso I, Farris A, Pluchinotta A, Isola G. Update of the Phase III trial 'GRETA' of surgery and tamoxifen versus tamoxifen alone for early breast cancer in elderly women. Future Oncol 2014; 11:933-41. [PMID: 25383659 DOI: 10.2217/fon.14.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In the Phase III 'GRETA' trial 474 women aged ≥70 years with early breast cancer were randomly assigned to surgery plus tamoxifen for 5 years or tamoxifen alone for 5 years. This is a long-term update. PATIENTS & METHODS Focusing on patients still alive in 2003, outcome end points has been recalculated. RESULTS Median distant metastases disease-free survival is longer with tamoxifen alone for 5 years; (48.8 vs 37.9 months; p = 0.009). No difference was found in distant metastases rate, disease-free survival, breast cancer and overall survival. CONCLUSION Primary endocrine treatment until the the best response, followed by minimal surgery and prosecution endocrine treatment for 5-10 years is a suitable option for elderly breast cancer patients. Delayed surgery does not prejudice overall survival.
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Adjogatse D, Thanopoulou E, Okines A, Thillai K, Tasker F, Johnston S, Harper-Wynne C, Torrisi E, Ring A. Febrile Neutropaenia and Chemotherapy Discontinuation in Women Aged 70 Years or Older Receiving Adjuvant Chemotherapy for Early Breast Cancer. Clin Oncol (R Coll Radiol) 2014; 26:692-6. [DOI: 10.1016/j.clon.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
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Soncini D, Caffa I, Zoppoli G, Cea M, Cagnetta A, Passalacqua M, Mastracci L, Boero S, Montecucco F, Sociali G, Lasigliè D, Damonte P, Grozio A, Mannino E, Poggi A, D'Agostino VG, Monacelli F, Provenzani A, Odetti P, Ballestrero A, Bruzzone S, Nencioni A. Nicotinamide phosphoribosyltransferase promotes epithelial-to-mesenchymal transition as a soluble factor independent of its enzymatic activity. J Biol Chem 2014; 289:34189-204. [PMID: 25331943 DOI: 10.1074/jbc.m114.594721] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Boosting NAD(+) biosynthesis with NAD(+) intermediates has been proposed as a strategy for preventing and treating age-associated diseases, including cancer. However, concerns in this area were raised by observations that nicotinamide phosphoribosyltransferase (NAMPT), a key enzyme in mammalian NAD(+) biosynthesis, is frequently up-regulated in human malignancies, including breast cancer, suggesting possible protumorigenic effects for this protein. We addressed this issue by studying NAMPT expression and function in human breast cancer in vivo and in vitro. Our data indicate that high NAMPT levels are associated with aggressive pathological and molecular features, such as estrogen receptor negativity as well as HER2-enriched and basal-like PAM50 phenotypes. Consistent with these findings, we found that NAMPT overexpression in mammary epithelial cells induced epithelial-to-mesenchymal transition, a morphological and functional switch that confers cancer cells an increased metastatic potential. However, importantly, NAMPT-induced epithelial-to-mesenchymal transition was found to be independent of NAMPT enzymatic activity and of the NAMPT product nicotinamide mononucleotide. Instead, it was mediated by secreted NAMPT through its ability to activate the TGFβ signaling pathway via increased TGFβ1 production. These findings have implications for the design of therapeutic strategies exploiting NAD(+) biosynthesis via NAMPT in aging and cancer and also suggest the potential of anticancer agents designed to specifically neutralize extracellular NAMPT. Notably, because high levels of circulating NAMPT are found in obese and diabetic patients, our data could also explain the increased predisposition to cancer of these subjects.
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Affiliation(s)
| | | | - Gabriele Zoppoli
- the Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium, the Laboratory of Molecular Pharmacology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Michele Cea
- From the Department of Internal Medicine, the Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston Novartis Institutes for BioMedical Research, Cambridge, Massachusetts 02139
| | - Antonia Cagnetta
- the Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston Novartis Institutes for BioMedical Research, Cambridge, Massachusetts 02139
| | - Mario Passalacqua
- Department of Experimental Medicine, Section of Biochemistry, and Italian Institute of Biostructures and Biosystems, University of Genoa, 16132 Genoa, Italy
| | - Luca Mastracci
- Department of Integrated Surgical and Diagnostic Sciences, Pathology Unit, University of Genoa, 16132 Genoa, Italy, the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Silvia Boero
- the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Fabrizio Montecucco
- From the Department of Internal Medicine, the Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, University of Geneva, 1211 Geneva, Switzerland
| | - Giovanna Sociali
- Department of Experimental Medicine, Section of Biochemistry, and Center of Excellence for Biomedical Research, and
| | | | | | - Alessia Grozio
- Department of Experimental Medicine, Section of Biochemistry, and Center of Excellence for Biomedical Research, and
| | - Elena Mannino
- Department of Experimental Medicine, Section of Biochemistry, and Center of Excellence for Biomedical Research, and
| | - Alessandro Poggi
- the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Vito G D'Agostino
- the Laboratory of Genomic Screening, Centre for Integrative Biology, University of Trento, 38123 Trento, Italy, and
| | | | - Alessandro Provenzani
- the Laboratory of Genomic Screening, Centre for Integrative Biology, University of Trento, 38123 Trento, Italy, and
| | - Patrizio Odetti
- From the Department of Internal Medicine, the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Alberto Ballestrero
- From the Department of Internal Medicine, the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy
| | - Santina Bruzzone
- Department of Experimental Medicine, Section of Biochemistry, and Center of Excellence for Biomedical Research, and
| | - Alessio Nencioni
- From the Department of Internal Medicine, the Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino-Istituto Scientifico Tumori, Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy,
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van de Water W, Kiderlen M, Bastiaannet E, Westendorp RG, van de Velde CJH, de Craen AJM, Liefers GJ. Response. J Natl Cancer Inst 2014; 106:dju272. [DOI: 10.1093/jnci/dju272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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325
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Reginelli A, Calvanese M, Ravo V, Di Franco R, Silvestro G, Gatta G, Squillaci E, Grassi R, Cappabianca S. Management of breast cancer in elderly patients. Int J Surg 2014; 12 Suppl 2:S187-S192. [DOI: 10.1016/j.ijsu.2014.08.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
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Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†. Ann Oncol 2014; 25:1871-1888. [PMID: 25234545 PMCID: PMC4176456 DOI: 10.1093/annonc/mdu385] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - L Norton
- Breast Cancer Program, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - M Aapro
- Division of Oncology, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology/Radiumhemmet, Karolinska Institutet & Cancer Center Karolinska and Karolinska University Hospital, Stockholm, Sweden
| | - L Biganzoli
- Department of Medical Oncology, Sandro Pitigliani Oncology Centre, Prato, Italy
| | - K L Blackwell
- Breast Cancer Clinical Program, Duke Cancer Institute, Durham, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - T Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - N El Saghir
- NK Basile Cancer Institute Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - D Fenech
- Breast Care Support Group, Europa Donna Malta, Mtarfa, Malta
| | - P Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- BC Cancer Agency, Vancouver, Canada
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA
| | - J Gligorov
- APHP Tenon, IUC-UPMC, Francilian Breast Intergroup, AROME, Paris, France
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - N Harbeck
- Brustzentrum der Universität München, Munich, Denmark
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - C Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - U N Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - S D Merjaver
- University of Michigan Medical School and School of Public Health, Ann Arbor, USA
| | - E B Nordström
- Europa Donna Sweden & Bröstcancerföreningarnas Riksorganisation, BRO, Sundbyberg, Sweden
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - A Partridge
- Department Medical Oncology, Division of Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - F Penault-Llorca
- Jean Perrin Centre, Comprehensive Cancer Centre, Clermont Ferrand, France
| | - M J Piccart
- Department of Medicine, Institut Jules Bordet, Brussels, Belgium
| | - H Rugo
- Department of Medicine, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - G Sledge
- Indiana University Medical CTR, Indianapolis, USA
| | - C Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - L Van't Veer
- Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - D Vorobiof
- Sandton Oncology Centre, Johannesburg, South Africa
| | - C Vrieling
- Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland
| | - N West
- Nursing Division, Health Board, Cardiff and Vale University, Cardiff, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - E Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
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327
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Clinically cN0 breast cancer in elderly: What surgery? Int J Surg 2014; 12 Suppl 2:S130-S134. [DOI: 10.1016/j.ijsu.2014.08.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 12/31/2022]
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328
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Sattar S, Alibhai SMH, Wildiers H, Puts MTE. How to implement a geriatric assessment in your clinical practice. Oncologist 2014; 19:1056-68. [PMID: 25187477 PMCID: PMC4200997 DOI: 10.1634/theoncologist.2014-0180] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022] Open
Abstract
Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
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Affiliation(s)
- Schroder Sattar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Shabbir M H Alibhai
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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Wenz F, Sperk E, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Piroth MD, Sautter-Bihl ML, Sedlmayer F, Souchon R, Fussl C, Sauer R. DEGRO practical guidelines for radiotherapy of breast cancer IV: radiotherapy following mastectomy for invasive breast cancer. Strahlenther Onkol 2014; 190:705-14. [PMID: 24888511 DOI: 10.1007/s00066-014-0687-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. METHODS The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio >20 %, resection margins <3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size >2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. RESULTS The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, >3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. CONCLUSION PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present.
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Affiliation(s)
- Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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Mariano C, Francl M, Pope J, Wong L, Lim HJ, Lohrisch C. Comparison of toxicity experienced by older versus younger patients enrolled in breast cancer clinical trials. Clin Breast Cancer 2014; 15:73-9. [PMID: 25445420 DOI: 10.1016/j.clbc.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elderly patients form a large proportion of patients with breast cancer but are underrepresented in clinical trials. We examined whether elderly patients experience more toxicity than younger patients within breast cancer clinical trials. MATERIALS AND METHODS All breast cancer trials open from 1999 to 2012 at BCCA, Vancouver Center, were reviewed. The primary endpoint was meaningful toxicity (MTOX), defined as any grade 3 or 4 adverse event (AE), any AE leading to dose delay or reduction, or premature discontinuation of therapy. RESULTS In the 46 trials enrolling 799 patients, the therapy given was chemotherapy to 18% of the patients, hormonal therapy to 40%, skeletal therapy to 14%, and targeted therapy and a combination of chemotherapy and targeted therapy to 14%. Elderly patients were more likely to enroll in hormonal and skeletal therapy trials, and younger patients were evenly distributed among the therapy types. Toxicity data were available for 778 patients (97%). Elderly patients and younger patients experienced a similar number and frequency of MTOX. The therapy type was the strongest predictor of toxicity on multivariate analysis. In non-chemotherapy-containing trials, elderly and younger patients had a similar frequency and number of toxicities. Few elderly patients were enrolled in cytotoxic chemotherapy trials, but they experienced no more toxicity than did the younger patients. CONCLUSION The appropriate selection of elderly patients using eligibility criteria, self selection, and/or clinician assessment will allow safe participation of elderly patients in breast cancer trials.
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Affiliation(s)
- Caroline Mariano
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
| | - Mia Francl
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Janice Pope
- Clinical Trials Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Linda Wong
- Clinical Trials Unit, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Howard J Lim
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caroline Lohrisch
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Syed BM, Parks RM, Cheung KL. Management of operable primary breast cancer in older women. WOMENS HEALTH 2014; 10:405-22. [PMID: 25259901 DOI: 10.2217/whe.14.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A considerable number of breast cancer diagnoses are made in older women. Differing physiological needs of older patients and biology of tumors compared with younger patients may alter treatment options between surgery and nonsurgical primary approaches. Adjuvant therapies may benefit these patients; however, concerns about toxicity and physical demands of treatment may affect patient choice regarding treatment. Furthermore, quality of life may be more important to the older individual than curative treatment alone. Growing evidence is emerging for employing Comprehensive Geriatric Assessment to determine other factors that may contribute to treatment decision-making in the older population. The way geriatric oncology is delivered varies, bringing the importance of the multidisciplinary team to the forefront of care delivery in this age group. Future research in this area should include combined consideration of tumor biology and geriatric needs.
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Affiliation(s)
- Binafsha M Syed
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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332
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Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast 2014; 23:489-502. [PMID: 25244983 DOI: 10.1016/j.breast.2014.08.009] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - L Norton
- Breast Cancer Program, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - M Aapro
- Division of Oncology, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology/Radiumhemmet, Karolinska Institutet & Cancer Center Karolinska and Karolinska University Hospital, Stockholm, Sweden
| | - L Biganzoli
- Department of Medical Oncology, Sandro Pitigliani Oncology Centre, Prato, Italy
| | - K L Blackwell
- Breast Cancer Clinical Program, Duke Cancer Institute, Durham, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - T Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - N El Saghir
- NK Basile Cancer Institute Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - D Fenech
- Breast Care Support Group, Europa Donna Malta, Mtarfa, Malta
| | - P Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- BC Cancer Agency, Vancouver, Canada
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA
| | - J Gligorov
- APHP Tenon, IUC-UPMC, Francilian Breast Intergroup, Arome, Paris, France
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - N Harbeck
- Brustzentrum der Universität München, Munich, DE, USA
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - C Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - U N Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Mayer
- Advanced BC.org, New York, USA
| | - S D Merjaver
- University of Michigan Medical School and School of Public Health, Ann Arbor, USA
| | - E B Nordström
- Europa Donna Sweden & Bröstcancerföreningarnas Riksorganisation, BRO, Sundbyberg, Sweden
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - A Partridge
- Department Medical Oncology, Division of Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - F Penault-Llorca
- Jean Perrin Centre, Comprehensive Cancer Centre, Clermont Ferrand, France
| | - M J Piccart
- Department of Medicine, Institut Jules Bordet, Brussels, Belgium
| | - H Rugo
- Department of Medicine, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - G Sledge
- Indiana University Medical CTR, Indianapolis, USA
| | - C Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, DE, Germany
| | - L Van't Veer
- Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - D Vorobiof
- Sandton Oncology Centre, Johannesburg, South Africa
| | - C Vrieling
- Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland
| | - N West
- Nursing Division, Health Board, Cardiff and Vale University, Cardiff, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - E Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
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333
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Burton M, Collins K, Caldon LJM, Wyld L, Reed MWR. Information Needs of Older Women Faced with a Choice of Primary Endocrine Therapy or Surgery for Early-Stage Breast Cancer: A Literature Review. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0159-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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334
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Gupta S, Zhang J, Jerusalem G. The association of chemotherapy versus hormonal therapy and health outcomes among patients with hormone receptor-positive, HER2−negative metastatic breast cancer: experience from the patient perspective. Expert Rev Pharmacoecon Outcomes Res 2014; 14:929-40. [DOI: 10.1586/14737167.2014.949243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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335
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de Glas NA, Jonker JM, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, Liefers GJ, Portielje JEA, Hamaker ME. Impact of omission of surgery on survival of older patients with breast cancer. Br J Surg 2014; 101:1397-404. [DOI: 10.1002/bjs.9616] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/05/2014] [Accepted: 06/18/2014] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.
Methods
Patients aged 75 years and older with stage I–III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.
Results
Overall, 26 292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90·8 per cent in 1995 to 69·9 per cent in 2011 (P < 0·001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1·00 (95 per cent confidence interval (c.i.) 0·99 to 1·00) per year); nor did relative survival (relative excess risk 1·00 (0·98 to 1·02) per year).
Conclusion
Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.
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Affiliation(s)
- N A de Glas
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - J M Jonker
- Department of Geriatric Medicine, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - A J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Siesling
- Department of Research, Comprehensive Cancer Centre, Utrecht, The Netherlands
- MIRA Institute of Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands
| | - G-J Liefers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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336
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Metin Seker M, Yucel B, Seker A, Ay Eren A, Bahar S, Celasun G, Kacan T, Fuat Eren M, Babacan N, Bahceci A. Treatment and prognosis of breast cancer in elderly: Different from young patients? Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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337
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Kelly CM, Power DG, Lichtman SM. Targeted therapy in older patients with solid tumors. J Clin Oncol 2014; 32:2635-46. [PMID: 25071113 DOI: 10.1200/jco.2014.55.4246] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The introduction of targeted therapy has ushered in the era of personalized medicine in cancer therapy. The increased understanding of tumor heterogeneity has led to the determination of specific targets that can be exploited in treatment. This review highlights approved drugs in different therapeutic classes, including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, drugs targeted to the human epidermal growth factor receptor 2, BRAF-mutation targeted drugs, anti-epidermal growth factor receptor inhibitors, and anti-vascular endothelial growth factor therapy. There have not been elderly patient-specific trials of these therapies. Most of the data are extrapolated from larger trials in which older patients generally were a fraction of the participants. Therapeutic recommendations are made on the basis of this analysis with the recognition that the older clinical trial participants may not be representative of patients seen in daily practice. Patient selection and geriatric evaluation are critical for appropriate drug selection, dosing, and monitoring. With care, these therapies are a major step forward in the safe and effective treatment of older patients with cancer.
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Affiliation(s)
- Ciara M Kelly
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Derek G Power
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY
| | - Stuart M Lichtman
- Ciara M. Kelly and Derek G. Power, Mercy University Hospital, Cork, Ireland; and Stuart M. Lichtman, Memorial Sloan Kettering Cancer Center, Commack, NY.
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338
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Garimella V, Hussain T, Agarwal V, Radhakrishna S, Fox JN, Kneeshaw PJ, Long ED, Mahapatra TK, McManus PL, Lind MJ, Drew PJ, Cawkwell L. Clinical response to primary letrozole therapy in elderly patients with early breast cancer: possible role for p53 as a biomarker. Int J Surg 2014; 12:821-6. [PMID: 25010604 DOI: 10.1016/j.ijsu.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 01/23/2023]
Abstract
Primary tamoxifen therapy has been widely used to treat elderly women with ER-positive breast cancer in the past. Aromatase inhibitors may be more beneficial than tamoxifen when used as primary endocrine therapy in elderly patients. We aimed to retrospectively evaluate a series of elderly women with ER-positive breast cancer treated with primary letrozole therapy as sole therapy with a minimum of 5 years follow up. To identify possible predictive biomarkers a pilot immunohistochemical analysis was performed to assess the expression of PR, HER2, EGFR, BCL2 and p53. A total of 45 women, aged more than 70 years with a diagnosis of ER-positive breast cancer that was treated with primary letrozole therapy were identified. A case note review was undertaken to obtain clinical information. Formalin fixed paraffin embedded tumour tissue from diagnostic core biopsies was available for all patients. Immunohistochemical analysis was performed to establish the protein expression status of p53, PR, HER2, EGFR and BCL2. The mean age of the 45 patients was 87 years (range 70-101). Clinical benefit was seen in 60% of the patients. Median progression free survival was 53 months (95% CI - 34-72) and the median time to progression was 43 months (95% CI - 22-64). BCL2 was expressed in 45/45 (100%); PR in 38/45 (84%); EGFR in 13/45 (28%); HER2 in 9/45 (20%) and p53 in 5/45 (11%) of tissue samples. Positive expression of p53 was associated with poor progression free survival (p = 0.03) in this pilot study. This study demonstrates that letrozole as sole treatment appears to be a suitable treatment option for elderly patients with ER-positive breast cancer who are not fit for, or decline, surgery. The analysis of p53 in a larger study is warranted in order to assess its role as a biomarker in this patient group.
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Affiliation(s)
- Veerabhadram Garimella
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | - Tasadooq Hussain
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Vijay Agarwal
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Queens Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Selvi Radhakrishna
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | - John N Fox
- Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - Ervine D Long
- Histopathology Department, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | | | - Michael J Lind
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Queens Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Philip J Drew
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Lynn Cawkwell
- Postgraduate Medical Institute of the University of Hull, Hull, UK; Hull York Medical School, Hull, UK.
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339
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de Glas NA, Hamaker ME, Kiderlen M, de Craen AJM, Mooijaart SP, van de Velde CJH, van Munster BC, Portielje JEA, Liefers GJ, Bastiaannet E. Choosing relevant endpoints for older breast cancer patients in clinical trials: an overview of all current clinical trials on breast cancer treatment. Breast Cancer Res Treat 2014; 146:591-7. [DOI: 10.1007/s10549-014-3038-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/18/2014] [Indexed: 11/25/2022]
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340
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Turner N, Zafarana E, Becheri D, Mottino G, Biganzoli L. Breast cancer in the elderly: which lessons have we learned? Future Oncol 2014; 9:1871-81. [PMID: 24295417 DOI: 10.2217/fon.13.140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Management of older breast cancer patients is challenging due to a lack of good quality evidence regarding the role of adjuvant chemotherapy. Older women can benefit as much from adjuvant chemotherapy as younger women, although they have an increased risk of toxicities. Decisions regarding adjuvant chemotherapy should be made based on tumor biology and biological age, rather than chronological age. Geriatrician assessment can detect subtle functional deficits that may impact on the ability of the patient to tolerate chemotherapy; however, implementation of comprehensive geriatric assessment in the oncology setting is challenging. Instead, numerous frailty screening tools are in development. Future advances should incorporate more accurate and efficient means for determining the biological age of elderly breast cancer patients, which will better define the risk:benefit ratio of adjuvant chemotherapy.
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Affiliation(s)
- Natalie Turner
- Sandro Pitigliani' Medical Oncology Unit, Department of Oncology, Hospital of Prato, Istituto Toscano Tumori, Piazza dell'Ospedale 2, Prato, Italy
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341
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Muss HB. Adjuvant Chemotherapy in Older Women With Breast Cancer: Who and What? J Clin Oncol 2014; 32:1996-2000. [DOI: 10.1200/jco.2013.54.8586] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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342
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Mariano C, Jolly T. Inherited Cancer Susceptibility in an Elderly Adult. J Am Geriatr Soc 2014; 62:1406-8. [DOI: 10.1111/jgs.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline Mariano
- Division of Geriatric Medicine; University of North Carolina; Chapel Hill North Carolina
| | - Trevor Jolly
- Division of Geriatric Medicine; University of North Carolina; Chapel Hill North Carolina
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343
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Montroni I, Rocchi M, Santini D, Ceccarelli C, Ghignone F, Zattoni D, Nuvola G, Zanotti S, Ugolini G, Taffurelli M. Has breast cancer in the elderly remained the same over recent decades? A comparison of two groups of patients 70years or older treated for breast cancer twenty years apart. J Geriatr Oncol 2014; 5:260-5. [DOI: 10.1016/j.jgo.2014.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/13/2013] [Accepted: 02/25/2014] [Indexed: 01/21/2023]
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344
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Bates T, Evans T, Lagord C, Monypenny I, Kearins O, Lawrence G. A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women. Eur J Surg Oncol 2014; 40:1230-6. [PMID: 25081093 DOI: 10.1016/j.ejso.2014.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. METHODS 37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size. RESULTS The proportion of women not having surgery increased from 7-10% at ages 35-69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70-79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0-39, the deprived and certain ethnic groups (p < 0.02). CONCLUSIONS From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group.
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Affiliation(s)
- T Bates
- The Breast Unit, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK.
| | - T Evans
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
| | - C Lagord
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
| | - I Monypenny
- Llandough University Hospital, Cardiff CF 64 2XX, UK
| | - O Kearins
- Public Health England, Cancer Screening QA Reference Centre, Birmingham B3 2PW, UK
| | - G Lawrence
- Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK
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345
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Heil J, Fuchs V, Golatta M, Schott S, Wallwiener M, Domschke C, Sinn P, Lux MP, Sohn C, Schütz F. Extent of primary breast cancer surgery: standards and individualized concepts. ACTA ACUST UNITED AC 2014; 7:364-9. [PMID: 24647774 DOI: 10.1159/000343976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
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Affiliation(s)
- Joerg Heil
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Valerie Fuchs
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Michael Golatta
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Sarah Schott
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | | | | | - Peter Sinn
- Institut für Pathologie, Universität Heidelberg, Germany
| | - Michael P Lux
- Universitäts-Brustzentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, Germany
| | - Christof Sohn
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
| | - Florian Schütz
- Universitäts-Frauenklinik, Universitätsklinikum Heidelberg, Germany
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346
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Loibl S, Reinisch M. Present status of adjuvant chemotherapy for elderly breast cancer patients. ACTA ACUST UNITED AC 2014; 7:439-44. [PMID: 24715824 DOI: 10.1159/000345867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Elderly breast cancer patients are underrepresented in clinical trials, leading to a lack of knowledge regarding their tolerance of modern chemotherapy regimens. In addition, physicians are often reluctant to treat older patients with chemotherapy due to potential side effects. This article summarizes the up-to-date literature on chemotherapy in elderly patients with breast cancer, evaluates the impact of the patients' comorbidities and treatment alterations and aims to encourage treating patients adequately according to their disease in combination with the biological age rather than the chronological age alone. Finally, a short overview is given of the recruiting studies in Europe evaluating chemotherapy in elderly patients.
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Affiliation(s)
- Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany ; Städtische Kliniken Offenbach, Germany
| | - Mattea Reinisch
- German Breast Group, Neu-Isenburg, Germany ; Frauenklinik, Bürgerhospital Frankfurt/M., Germany
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347
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Stover AM, Mayer DK, Muss H, Wheeler SB, Lyons JC, Reeve BB. Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer. Cancer 2014; 120:1881-9. [PMID: 24647996 PMCID: PMC4047201 DOI: 10.1002/cncr.28649] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 01/13/2014] [Accepted: 02/03/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Health care providers have little population-based evidence about health-related quality of life (HRQOL) changes, from the pre- to postdiagnosis period, and treatment-related recovery time for women aged 65 years and older diagnosed with breast cancer. METHODS Older women with and without breast cancer completed self-reports of HRQOL at baseline and 2 years later as part of annual Medicare Health Outcomes Surveys (MHOS). MHOS was linked to Surveillance, Epidemiology, and End Results registries, which were used to categorize women with breast cancer by treatment type (breast-conserving surgery, breast-conserving surgery plus radiation, mastectomy) and time since diagnosis at follow-up. Each cancer case diagnosed in 1998 through 2007 (N = 542) was matched to 5 women without cancer (N = 2710) using propensity score matching. Analysis of covariance models examined changes in HRQOL, adjusting for demographics and initial functioning. RESULTS Older women within 6 months of diagnosis had greater declines than women without cancer in SF-36 Physical (-5.8 vs -1.8) and Mental (-3.6 vs -0.7) Component Summary scores, General Health (-12.3 vs -4.6), Vitality (-11.0 vs -2.2), Bodily Pain (-8.5 vs -2.1), Social Functioning (-15.1 vs -3.3), Role-Physical (-26.5 vs -3.9), and Role-Emotional (-13.1 vs -3.1) scores (all P < .05). By approximately 1 year, women with and without breast cancer had similar HRQOL. Comparable declines in Physical Component Summary and Role-Physical occurred across treatment types. CONCLUSIONS Women aged 65 years and older diagnosed with breast cancer should be counseled that survivors within 6 months of diagnosis are vulnerable to HRQOL declines, compared to women without breast cancer, but that decrements generally wane after 12 months.
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Affiliation(s)
- Angela M. Stover
- Health Behavior, University of North Carolina – Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina – Chapel Hill
| | - Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
- School of Medicine, University of North Carolina – Chapel Hill
| | - Hyman Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
- School of Medicine, University of North Carolina – Chapel Hill
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
- Health Policy and Management, University of North Carolina – Chapel Hill
| | - Jessica C. Lyons
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
| | - Bryce B. Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina – Chapel Hill
- Health Policy and Management, University of North Carolina – Chapel Hill
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348
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de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJM, Kroep JR, Putter H, Stiggelbout AM, Weijl NI, van de Velde CJH, Portielje JEA, Liefers GJ. Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol 2014; 15:722-9. [DOI: 10.1016/s1470-2045(14)70200-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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349
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Campana LG, Galuppo S, Valpione S, Brunello A, Ghiotto C, Ongaro A, Rossi CR. Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations. J Cancer Res Clin Oncol 2014; 140:1557-65. [PMID: 24793549 DOI: 10.1007/s00432-014-1691-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/19/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients. METHODS Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70 years (n = 27) and those ≥70 years (n = 28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance. RESULTS Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (range 6-53). Overall, CR rate was 40 % and was significantly higher in elderly patients (57 vs. 26 %, P = .023) and in patients with better performance status (PS = 0-1, 53 vs. PS = 2, 21 %, P = .048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93 % among elderly and young patients, respectively; P = .061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30 %, P = .075), but discontinued treatment more frequently due to impaired performance status (P = .002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1 %) and 8/28 (28.6 %) elderly patients at 4 and 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration. CONCLUSIONS Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection.
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Affiliation(s)
- Luca G Campana
- Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata, 64, 35128, Padua, Italy,
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350
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Portrait, treatment choices and management of breast cancer in nonagenarians: an ongoing challenge. Breast 2014; 23:221-5. [PMID: 24725451 DOI: 10.1016/j.breast.2014.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/22/2022] Open
Abstract
There are only scarce data on the management of nonagenarians with breast cancer, and more particularly on the place of radiation therapy (RT). We report a retrospective study on patients aged 90 years old or older, with breast cancer, receiving RT. Records from RT departments from five institutions were reviewed to identify patients 90 years old of age and older undergoing RT over past decade for breast cancer. Tumors' characteristics were examined, as well treatment specificities and treatment intent. 44 patients receiving RT courses were identified, mean age 92 years. Treatment was given with curative and palliative intent in 72.7% and 27.3% respectively. Factors associated with a curative treatment were performance status (PS), place of life, previous surgery, and tumor stage. Median total prescribed dose was 40 Gy (23-66). Hypo fractionation was used in 77%. Most toxicities were mild to moderate. RT could not be completed in 1 patient (2.3%). No long-term toxicity was reported. Among 31 patients analyzable for effectiveness, 24 patients (77.4%) had their diseased controlled until last follow-up, including 17 patients (54.8%) experiencing complete response. At last follow-up, 4 patients (12.9%) were deceased, cancer being cause of death for two of them. The study shows that breast/chest RT is feasible in nonagenarians. Although the definitive benefit of RT could not be addressed here, hypofractionated therapy allowed a good local control with acceptable side effects.
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