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Sedloev T, Spirdonov J, Terziev I, Spiridonova T, Usheva S. Bilateral Synchronous Locally Advanced Carcinoma of the Breast in a Woman Over 100 Years Old. Br J Hosp Med (Lond) 2022; 83:1-3. [PMID: 36594771 DOI: 10.12968/hmed.2022.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Theophil Sedloev
- Department of Surgery, University Hospital 'Tzaritza Joanna - ISUL', Medical University of Sofia, Sofia, Bulgaria
| | - Jordan Spirdonov
- Department of Medical Imaging, University Hospital 'Tzaritza Joanna - ISUL', Medical University of Sofia, Sofia, Bulgaria
| | - Ivan Terziev
- Department of General and Clinical Pathology, University Hospital 'Tzaritza Joanna - ISUL', Medical University of Sofia, Sofia, Bulgaria
| | | | - Slavyana Usheva
- Department of Surgery, University Hospital 'Tzaritza Joanna - ISUL', Medical University of Sofia, Sofia, Bulgaria
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Lamm R, Woodward SG, Varshney K, Lyons W, Anne PR, George BJ, Willis AI. A comparison of timely completion of hypofractionated and traditional adjuvant radiation therapy in early-stage breast cancer: Evidence of impact on reducing racial and socioeconomic disparities. Surgery 2022; 172:31-40. [PMID: 35489980 DOI: 10.1016/j.surg.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely completion of adjuvant radiation after breast conservation therapy is associated with decreased mortality and increased disease-free survival. Few data exist comparing timely completion between hypofractionated radiation and traditional radiation at a national level or across racial and socioeconomic cohorts. METHODS A retrospective review of the National Cancer Database (2012-2016) on patients undergoing breast conservation therapy for early-stage breast cancer, specifically T1 or T2, N0, M0 patients, was performed. Multivariable logistic regression models were used to compare timely completion of hypofractionated radiation (within 5 weeks of initiation) and traditional radiation (within 7 weeks) across patient, tumor, and facility characteristics. RESULTS In total, 210,816 patients met criteria, with 59.4% receiving traditional radiation (n = 125,140) and 40.6% receiving hypofractionated radiation (n = 85,676). Overall, 82.8% of patients achieved timely completion of radiation. Among hypofractionated radiation patients, 94.5% of patients achieved timely completion, whereas only 74.8% of traditional radiation patients achieved timely completion (P < .0001). Regarding race/ethnicity, all groups benefited substantially in timely completion of hypofractionated radiation over traditional radiation. However, both treatment cohorts demonstrated that Black (odds ratio (hypofractionated radiation) = 0.842, odds ratio (traditional radiation) = 0.821) and Hispanic (odds ratio (hypofractionated radiation) = 0.917, odds ratio (traditional radiation) = 0.907) patients had lower odds of timely completion compared to White patients (P < .0001). Lower high school graduation rate, median income for patients' ZIP code, and Medicaid were also associated with lower odds of timely completion for both hypofractionated radiation and traditional radiation (both P < .0001). CONCLUSION Timely completion of radiation therapy in breast conservation therapy is greater for patients receiving hypofractionated radiation than traditional radiation across racial and socioeconomic cohorts. Disparities in timely completion were substantially reduced with hypofractionated radiation utilization. However, there are treatment disparities across racial and socioeconomic cohorts that persist in both treatment groups.
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Affiliation(s)
- Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Steven G Woodward
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Karan Varshney
- Thomas Jefferson University, College of Population Health, Philadelphia, PA
| | - Walker Lyons
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Pramila R Anne
- Deparment of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brandon J George
- Thomas Jefferson University, College of Population Health, Philadelphia, PA; Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
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Campos Magalhães Garcia LS, Garcia Trigo ML. Results of accelerated partial breast irradiation in patients not suitable for external beam irradiation stratified by GEC-ESTRO, ASTRO, and ABS guidelines. Brachytherapy 2020; 20:315-325. [PMID: 33199176 DOI: 10.1016/j.brachy.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to review the outcome of an institution in multicatheter/interstitial accelerated partial breast irradiation (MC-APBI) for treatment of patients with breast cancer, either with strong criteria for APBI or unable to be treated with whole-breast irradiation. The outcomes were also stratified by the American Society for Radiation Oncology, American Brachytherapy Society, and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology patient selection criteria. METHODS The study includes 118 patients and 120 MC-APBI treatments, treated in a single tertiary center, between November 2003 and August 2016. The analysis is focused on the clinical baseline characteristics, local control, relapse-free survival, disease-specific survival (DSS), and overall survival. RESULTS In accordance to the American Society for Radiation Oncology, American Brachytherapy Society, and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology, 17.1% were "unsuitable," 19.2% were "unacceptable," and 19.5% were "high risk," respectively. The main reasons why high-risk patients were submitted to MC-APBI were as follows: cardiopathy (n = 7), social difficulties (n = 4), and mobility limitations (n = 4). At the median followup period of 86.5 months, ipsilateral breast tumor recurrence was observed in one (0.8%) patient. The 3-year and 5-year relapse-free survival were 100% and 99.1%, respectively. DSS was 100%. CONCLUSIONS This study demonstrated excellent control rates, DFS, and DSS of MC-APBI, rendering APBI as an excellent treatment for patients with breast cancer, even those who are not necessarily eligible for this treatment approach. The selection criteria for ABPI diverge according to different guidelines and are based on studies with discrepancies, making extremely possible that these recommendations could be changed.
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Affiliation(s)
| | - Maria Lurdes Garcia Trigo
- Department of Brachytherapy, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
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Sumodhee S, Pujalte M, Gal J, Cham Kee DL, Gautier M, Schiappa R, Chand ME, Hannoun-Levi JM. Accelerated partial breast irradiation in the elderly: 8-year oncological outcomes and prognostic factors. Brachytherapy 2020; 20:146-154. [PMID: 33132071 DOI: 10.1016/j.brachy.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study is to evaluate long-term clinical outcomes and prognostic factors after accelerated partial breast irradiation (APBI) in the elderly using high-dose-rate interstitial multicatheter brachytherapy (HIBT). METHODS AND MATERIALS Between 2005 and 2018, 109 patients underwent APBI using HIBT (34 Gy/10f/5d or 32 Gy/8f/4d). Based on a prospective database, outcomes were retrospectively analyzed (local relapse-free survival, metastatic-free survival, specific survival (SS), and overall survival (OS)). Prognostic factors were investigated. Late toxicity and cosmetic evaluation were reported. RESULTS With a median followup of 97 months [7-159], median age was 81.7 years [58-89]. In accordance with the GEC-ESTRO APBI classification, 72.5%, 11.9%, and 15.6% were classified as low, intermediate, and high risk, respectively. The histological type was mainly invasive ductal carcinoma (87.1%). The median tumor size was 10 mm [range 1-35]. Eight-year local relapse-free survival, SS, and OS were 96.7% [95% confidence interval (CI) [0.923; 1]), 96.7% [95% CI [0.924; 1], and 72% [95% CI [0.616; 0.837], respectively. In univariate analysis, APBI classification was not considered as prognostic factor, whereas molecular classification was prognostic factor for OS (p < 0.0001), SS (p = 0.007), and metastatic-free survival (p = 0.009) but not for local recurrence (p = 0.586). No Grade ≥3 late toxicity was observed, whereas 61 patients (88.4%) and 8 patients (11.6%) presented Grade 1 and 2 toxicities, respectively. The cosmetic outcome was excellent/good for 96.4%. CONCLUSIONS Long-term followup confirms that HIBT is safe and effective for elderly early breast cancer. Our results suggest that selected elderly women presenting with high-risk breast cancer could be also considered for APBI.
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Affiliation(s)
- Shakeel Sumodhee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Marc Pujalte
- Department of Medical Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jocelyn Gal
- Biostatistics Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Department of Medical Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center & University of Cote d'Azur, Nice, France.
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Hannoun-Lévi JM, Lam Cham Kee D, Gal J, Schiappa R, Hannoun A, Fouche Y, Gautier M, Boulahssass R, Chand ME. Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial. Brachytherapy 2019; 19:90-96. [PMID: 31767533 DOI: 10.1016/j.brachy.2019.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of a very-accelerated partial breast irradiation (vAPBI) in the elderly based on a single fraction of multicatheter interstitial high-dose rate brachytherapy (MIB). Mature results with a median follow-up of 5 years. METHODS AND MATERIALS From November 2012 to September 2014, 26 patients (pts) (≥70) with early breast cancer were enrolled in a prospective phase II trial (NCT01727011). After lumpectomy, intraoperative catheter implant was performed for postoperative APBI (single fraction 16 Gy). Surveillance was performed twice a year after APBI. Oncologic outcome (local [LRFS], metastasis-free survival, cancer-specific survival, and overall survival [OS]) as well as late toxicity and cosmetic outcome were investigated. RESULTS Median age was 77 years [69-89]. After a median follow-up of 63 months [60-68], 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival rates were 100%, 95.5%, 100%, and 88.5%, respectively. Late toxicity was observed in 5 pts (19.2%) with a total of five events: 3 pts G1 (60%); and 2 pts G2 (40%). The observed late side effects were breast pain in 1 pt (G2 cytosteatonecrosis with occasional acetaminophen consumption), hypopigmentation (puncture site) in 2 pts (G1) and breast fibrosis in 2 pts (G1: 1 pt; G2: 1 pt). Cosmetic evaluation was excellent for 21 pts (81%) and good for 2 pts (19%). CONCLUSION For elderly with early breast cancer, a vAPBI using a single fraction of postoperative MIB (16 Gy) provides excellent oncologic results, mainly in terms of local control and cancer death. Late toxicity and cosmetic profile are acceptable.
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Affiliation(s)
- Jean-Michel Hannoun-Lévi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
| | - Daniel Lam Cham Kee
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jocelyn Gal
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | | | - Yves Fouche
- Department of Breast Surgery, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Rabia Boulahssass
- Geriatric Unit, CHU de NICE, FHU ONCOAGE, University of Cote d'Azur, Nice, France
| | - Marie-Eve Chand
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
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Foerster M, Anderson BO, McKenzie F, Galukande M, Anele A, Adisa C, Zietsman A, Schuz J, dos Santos Silva I, McCormack V. Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study. Breast Cancer Res 2019; 21:93. [PMID: 31409419 PMCID: PMC6691541 DOI: 10.1186/s13058-019-1174-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/22/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Improving breast cancer survival in sub-Saharan Africa (SSA) is urgently needed, requiring early diagnosis and improved access to treatment. However, data on the types of and barriers to receiving breast cancer therapy in this region are limited and have not been compared between different SSA countries and treatment settings. METHODS In different health care settings across Uganda, Nigeria and Namibian sites of the prospective African Breast Cancer - Disparities in Outcomes cohort study, we assessed the percentage of newly diagnosed breast cancer patients who received treatment (systemic, surgery and/or radiotherapy) for cancer and their socio-demographic and clinical determinants. Treatment data were systematically extracted from medical records, as well as self-reported by women during 6-month follow-up interviews, and were used to generate a binary indicator of treatment received within 12 months of diagnosis (yes/no), which was analysed via logistic regression. RESULTS Of 1325 women, cancer treatment had not been initiated treatment within 1 year of diagnosis for 227 (17%) women and 185 (14%) of women with stage I-III disease. Untreated percentages were highest in two Nigerian regional hospitals where 38% of 314 women were not treated (32% among stage I-III). At a national referral hospital in Uganda, 18% of 430 women were not treated (15% among stage I-III). In contrast, at a cancer care centre in Windhoek, Namibia, where treatment is provided free to the patient, all non-black (100%) and almost all (98.7%) black women had initiated treatment. Percentages of untreated women were higher in women from lower socio-economic groups, women who believed in traditional medicine and, in Uganda, in HIV+ women. Self-reported treatment barriers confirmed treatment costs and treatment refusal as contributors to not receiving treatment. CONCLUSIONS Financial support to ensure treatment access and education of treatment benefits are needed to improve treatment access for breast cancer patients across sub-Saharan Africa, especially at regional treatment centres, for lower socio-economic groups, and for the HIV-positive woman with breast cancer.
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Affiliation(s)
- Milena Foerster
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, France
| | | | - Fiona McKenzie
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, France
| | | | | | - Charles Adisa
- Abia State University Teaching Hospital, Aba, Nigeria
| | | | - Joachim Schuz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, France
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, France
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Garcia-Etienne CA, Ferrari A, Della Valle A, Lucioni M, Ferraris E, Di Giulio G, Squillace L, Bonzano E, Lasagna A, Rizzo G, Tancredi R, Scotti Foglieni A, Dionigi F, Grasso M, Arbustini E, Cavenaghi G, Pedrazzoli P, Filippi AR, Dionigi P, Sgarella A. Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center. Eur J Surg Oncol 2019; 46:15-23. [PMID: 31445768 DOI: 10.1016/j.ejso.2019.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/22/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
The surgical approach to the axilla in breast cancer has been a controversial issue for more than three decades. Data from recently published trials have provided practice-changing recommendations in this scenario. However, further controversies have been triggered in the surgical community, resulting in heterogeneous diffusion of these recommendations. The development of clinical guidelines for the management of the axilla in patients with breast cancer is a work in progress. A multidisciplinary team discussion was held at the research hospital Policlinico San Matteo from the Università degli Studi di Pavia with the aim to update recommendations for the management of the axilla in patients with breast cancer. An evidence-based approach is presented. Our multidisciplinary panel determined that axillary dissection after a positive sentinel lymph node biopsy may be avoided in cN0 patients with micro/macrometastasis to ≤2 sentinel nodes, with age ≥40y, lesions ≤3 cm, who have not received neoadjuvant chemotherapy and have planned breast conservation (BCS) with whole breast radiotherapy (WBRT). Cases with gross (>2 mm) ECE in SLNs are evaluated on individual basis for completion ALND, axillary radiotherapy or omission of both. Patients fulfilling the criteria listed above who undergo mastectomy, may also avoid axillary dissection after multidisciplinary discussion of individual cases for consideration of axillary irradiation. Women 70 years or older with hormone receptors positive invasive lesions ≤3 cm, clinically negative nodes, and serious or multiple comorbidities who undergo BCS with WBRT, may forgo axillary staging/surgery (if mastectomy or larger tumor, comorbidities and life expectancy are taken into account).
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Affiliation(s)
- Carlos A Garcia-Etienne
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy.
| | - Alberta Ferrari
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Angelica Della Valle
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Marco Lucioni
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Elisa Ferraris
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giuseppe Di Giulio
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Luigi Squillace
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Elisabetta Bonzano
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Angioletta Lasagna
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Gianpiero Rizzo
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Richard Tancredi
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Andrea Scotti Foglieni
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Francesca Dionigi
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Grasso
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Eloisa Arbustini
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giorgio Cavenaghi
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Andrea R Filippi
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Paolo Dionigi
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Adele Sgarella
- Breast Center, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
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Leinert E, Schwentner L, Blettner M, Wöckel A, Felberbaum R, Flock F, Kühn T, Denkinger MD, Janni W, Kreienberg R, Singer S. Association between cognitive impairment and guideline adherence for application of chemotherapy in older patients with breast cancer: Results from the prospective multicenter BRENDA II study. Breast J 2019; 25:386-392. [PMID: 30945393 DOI: 10.1111/tbj.13231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined the association between cognitive impairment and guideline adherence for application of chemotherapy in older patients with breast cancer. PATIENTS AND METHODS In the prospective multicenter cohort study BRENDA II, patients aged ≥65 years with primary breast cancer were sampled over a period of 4 years (2009-2012). A multiprofessional team (tumor board) discussed recommendation for adjuvant chemotherapy according to the German S3 guideline. Cognitive impairment was screened by the clock-drawing test (CDT) prior to adjuvant treatment. RESULTS Two hundred and sixty-three patients were included in the study and CDT data were available for 193 patients. Thirty-one percent of the patients had cognitive impairment with different degree of severity. In high-risk patients (n = 61) tumor board recommendation in favor of chemotherapy was 90% and in intermediate-risk patients (n = 170) 27%. Not receiving recommendation for chemotherapy in spite of guideline recommendation was more frequent in patients with cognitive impairment (67%) vs patients without cognitive impairment (46%) with P = 0.02 (OR 2.4, 95% confidence interval (CI) 1.2-4.9). Age, education, migration background and comorbidities were not associated with chemotherapy recommendation by the tumor board among cognitively impaired patients. Once the tumor board had recommended chemotherapy, application of chemotherapy was similar in both groups of patients with or without cognitive impairment. CONCLUSION Almost one third of older patients with breast cancer are affected by cognitive impairment prior to adjuvant treatment. In these patients, cognitive impairment was associated with tumor board decision against chemotherapy in spite of a positive guideline recommendation.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Ricardo Felberbaum
- Department of Gynecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | - Felix Flock
- Department of Gynecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - Michael Dieter Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Hospital, Ulm University and Geriatric Center Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Rolf Kreienberg
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Park JH, Kim YS, Ahn SD, Choi EK, Shin SS, Kim YT, Kim YM, Kim JH, Yi SY, Nam JH. Concurrent Chemoradiotherapy or Radiotherapy Alone for Locally Advanced Cervical Cancer in Elderly Women. TUMORI JOURNAL 2018. [DOI: 10.1177/548.6516] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate the efficacy and toxicity of concurrent chemoradiotherapy or radiotherapy alone in elderly patients with locally advanced cervical carcinoma (stage IB2-IVA). Methods and study design We retrospectively reviewed the medical records of 105 women aged ≥65 years who received radiotherapy (group I, n = 61) or concurrent chemoradiotherapy (group II, n = 44). Patients received a median dose of 76.4 Gy to point A, including 30-35 Gy of high-dose intracavity brachytherapy. The concurrent chemoradiotherapy group received platinum-based chemotherapy. Results The median follow-up was 65 months for surviving patients. There was no significant difference in compliance to radiotherapy between the two groups. Most acute toxicities were hematologic; acute hematologic and gastrointestinal toxicity were significantly more common in group II. Five-year overall survival and cancer-specific survival rates were, respectively, 53.5% and 66.6% in group I and 61.8% and 68.8% in group II. Performance status, comorbidity index, tumor size, and stage were independent prognostic factors for overall survival, whereas stage was the only prognostic factor for cancer-specific survival. Conclusions The analysis showed no benefit of concurrent chemoradiotherapy with respect to overall survival and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. Free full text available at www.tumorionline.it
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Affiliation(s)
- Jin-hong Park
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young Seok Kim
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seung Do Ahn
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Eun Kyung Choi
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Soo Shin
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young-Tak Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Yong-Man Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Jong-Hyeok Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Seoul, Korea
| | - Joo-Hyun Nam
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
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10
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Accelerated partial breast irradiation for elderly women with early breast cancer: A compromise between whole breast irradiation and omission of radiotherapy. Brachytherapy 2017; 16:929-934. [DOI: 10.1016/j.brachy.2017.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 11/18/2022]
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11
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Chagpar AB, Hatzis C, Pusztai L, DiGiovanna MP, Moran M, Mougalian S, Sanft T, Evans S, Hofstatter E, Wilson LD, Lannin DR. Association of LN Evaluation with Survival in Women Aged 70 Years or Older With Clinically Node-Negative Hormone Receptor Positive Breast Cancer. Ann Surg Oncol 2017; 24:3073-3081. [PMID: 28766195 DOI: 10.1245/s10434-017-5936-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some suggest that lymph node (LN) evaluation not be performed routinely in women aged ≥70 years with clinically (c) LN-negative (-), hormone receptor (HR)-positive (+) breast cancer. We sought to determine the association of omission of LN evaluation on survival. METHODS Patients who met the above criteria and were diagnosed from 2004 to 2012 were identified in the NCDB and SEER databases. Overall survival (OS) and breast cancer-specific survival (BCSS) were determined. RESULTS Using the NCDB, we identified 157,584 cLN- HR+ patients aged ≥70 years in whom survival and LN evaluation data were available. A total of 126,638 patients (80.2%) had regional LN surgery. With a median follow-up of 41.6 months, there was a significant difference in OS between those who had LN evaluation and those who did not (median OS: 100.5 vs. 70.9 months, respectively, p < 0.001). After adjusting for patient age, race, insurance, income, comorbidities, tumor characteristics and treatment, patients who had undergone LN evaluation still had a lower hazard rate for death than those who had not (hazard ratio = 0.633; 95% confidence interval [CI] 0.613-0.654, p < 0.001). We then did a parallel analysis using SEER data that showed LN evaluation was associated with a lower hazard rate for both BCSS (hazard ratio = 0.452; 95% CI 0.427-0.479, p < 0.001) and non-BCSS (hazard ratio = 0.465; 95% CI 0.447-0.482, p < 0.001). CONCLUSIONS Roughly 20% of patients older than aged 70 years with cLN-, HR+ breast cancer did not have LN evaluation. Those who did had better OS controlling for sociodemographic, pathologic, and treatment variables; however, this may be due to patient selection.
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Affiliation(s)
- Anees B Chagpar
- Department of Surgery, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA.
| | - Christos Hatzis
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Lajos Pusztai
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Michael P DiGiovanna
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Meena Moran
- Department of Therapeutic Oncology, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Sarah Mougalian
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Suzanne Evans
- Department of Therapeutic Oncology, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Erin Hofstatter
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Lynn D Wilson
- Department of Therapeutic Oncology, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Donald R Lannin
- Department of Surgery, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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12
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Kamali P, Curiel D, van Veldhuisen CL, Bucknor AEM, Lee BT, Rakhorst HA, Lin SJ. Trends in immediate breast reconstruction and early complication rates among older women: A big data analysis. J Surg Oncol 2017; 115:870-877. [PMID: 28409847 DOI: 10.1002/jso.24595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although approximately 57% of breast cancer (BC) diagnoses are in older patients (>60 years), only 4.1-14% receives breast reconstruction (BR). This has been attributed to physician concerns about operative complications. This paper aims to: 1) analyze the 30-day complication rates in the older patient population undergoing immediate breast reconstruction (IBR); and 2) analyze links between complication type and category of reconstruction. METHODS Using the ACS-NSQIP database (2005-2014), all women older than 60 years of age diagnosed with BC and DCIS were identified. IBR and complication rates were plotted for all ages. Patients were divided into those with and those without complications. Patient demographics and co-morbidities were compared. Complications within each type of reconstruction were analyzed. RESULTS Of the 4450 BC and 1104 DCIS patients, 22.3% (BC) and 20.9% (DCIS) had complications. IBR decreased significantly with increased age (P < 0.00 in both cohorts), while complication rates remained stable across all ages (P = 0.32 in BC, P = 0.69 in DCIS patients). Patients were well matched in terms of demographics. CONCLUSIONS The rates of breast reconstruction decrease with increasing age. Despite increasing age, associated complication rates in IBR patients remained stable.
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Affiliation(s)
- Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Curiel
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Charlotte L van Veldhuisen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexandra E M Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hinne A Rakhorst
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Division of Plastic- Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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13
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Cardiac safety of adjuvant non-pegylated liposomal doxorubicin combined with cyclophosphamide and followed by paclitaxel in older breast cancer patients. Breast 2016; 31:186-191. [PMID: 27886643 DOI: 10.1016/j.breast.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) combined to Cyclophosphamide (CTX) and followed by weekly Paclitaxel, in older patients (≥65 years) with diagnosis of high risk breast cancer. The main end point of this prospective study was the detection of early episodes of symptomatic congestive heart failure (CHF). METHODS The cardiac function was evaluated by left ventricular ejection fraction (LVEF) measurements with repeated echocardiograms, performed 2 weeks before the beginning of chemotherapy and every 6 months, until 30 months after the study entry; then yearly for at least 5 years. RESULTS Forty-seven patients were enrolled from two Italian Divisions of Medical Oncology. Final results revealed no early episodes of symptomatic CHF within the first 12 months from the enrolment. Only two cardiac events were observed: an episode of atrial flutter after the first cycle of NPL-DOX and CTX, with a quick return to normal rhythm, and a grade 3 (scored to NCI-CTCAE, version 3.0) CHF episode, 18 months later chemotherapy start. No other relevant toxicities were reported. CONCLUSIONS This adjuvant combination including NPL-DOX in elderly patients, resulted in a low rate of cardiac toxic effects. Comparative trials should be encouraged to confirm these findings.
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14
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Leinert E, Singer S, Janni W, Harbeck N, Weissenbacher T, Rack B, Augustin D, Wischnik A, Kiechle M, Ettl J, Fink V, Schwentner L, Eichler M. The Impact of Age on Quality of Life in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Comparative Analysis From the Prospective Multicenter Randomized ADEBAR trial. Clin Breast Cancer 2016; 17:100-106. [PMID: 27884722 DOI: 10.1016/j.clbc.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/13/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly breast cancer patients are affected by poorer quality of life (QoL) compared to younger patients. Because QoL has a relevant impact on guideline-adherent treatment, elderly breast cancer patients are often undertreated, especially with regard to adjuvant chemotherapy, and overall survival is decreased. Thus, understanding the impact of chemotherapy on QoL in elderly patients is crucial. This study compared QoL in patients aged < 65 years and 65 to 70 years receiving adjuvant chemotherapy as a secondary outcome in the prospective randomized multicenter ADEBAR trial. PATIENTS AND METHODS Patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or epirubicin/fluorouracil/cyclophosphamid chemotherapy (FEC) therapy. QoL was assessed at baseline (t1), before cycle 4 FEC, and cycle 5 epirubicin/cyclophosphamid-docetaxel (EC-DOC) (t2), 4 weeks after chemotherapy (t3), and 6 weeks after radiation (t4) using the European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Breast Cancer-Specific Module (QLQ-BR23). We compared patients aged < 65 years and 65 to 70 years with respect to QoL and discontinuation of chemotherapy. RESULTS A total of 1363 patients were enrolled onto the ADEBAR trial, with 16.7% of the patients aged 65 to 70 years. In elderly patients, Eastern Cooperative Oncology Group performance status was higher and global health status and physical functioning were lower at baseline. Global health status decreased between t1 and t3 by 7 points in patients < 65 years and by 11 points in patients 65 to 70 years, and physical functioning decreased in the same period by 13.4 points in patients aged < 65 years and by 15.9 points in patients 65 to 70 years. In both groups, at t4 global health status exceeded baseline by 6 points, and physical functioning was 1.3 points under baseline in patients < 65 years old and 3 points under baseline in patients 65 to 70 years. There was a trend to more fatigue in elderly patients and to more nausea and vomiting while receiving chemotherapy in younger patients at t3. There was a higher dropout rate in patients aged 65 to 70 years (25.7%) than in patients aged < 65 years (16.2%). CONCLUSION There were only small or trivial differences in QoL in patients aged < 65 years versus 65 to 70 years who were receiving adjuvant chemotherapy, although the dropout rate from chemotherapy was notably higher in elderly breast cancer patients.
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Affiliation(s)
- Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
| | - Susanne Singer
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Nadia Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doris Augustin
- Breast Center of Eastern Bavaria, DONAUISAR Hospital, Deggendorf, Germany
| | | | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Martin Eichler
- Insitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
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15
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Rosenstock AS, Lei X, Tripathy D, Hortobagyi GN, Giordano SH, Chavez-MacGregor M. Short-term mortality in older patients treated with adjuvant chemotherapy for early-stage breast cancer. Breast Cancer Res Treat 2016; 157:339-350. [DOI: 10.1007/s10549-016-3815-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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16
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Advanced age is a predictor of 30-day complications after autologous but not implant-based postmastectomy breast reconstruction. Plast Reconstr Surg 2015; 135:253e-261e. [PMID: 25626808 DOI: 10.1097/prs.0000000000000988] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older breast cancer patients undergo postmastectomy breast reconstruction infrequently, in part because of a perception of increased surgical risk. This study sought to investigate the effects of age on perioperative complications after postmastectomy breast reconstruction. METHODS The American College of Surgeons National Surgery Quality Improvement Program Participant Use Files from 2005 to 2012 were used to identify women with breast cancer who underwent unilateral mastectomy alone or with immediate reconstruction. Thirty-day complication rates were compared between younger (<65 years) and older (≥65 years) women after implant-based reconstruction, autologous reconstruction, or mastectomy alone. Linear and logistic regression models were used to control for differences in comorbidities and age. RESULTS A total of 40,769 patients were studied, of whom 15,093 (37 percent) were aged 65 years or older. Breast reconstruction was performed in 39.5 percent of younger and 10.7 percent of older women. The attributable risks of breast reconstruction, manifested by longer hospital stays (p < 0.001), more frequent complications (p < 0.001), and more reoperations (p < 0.001), were similar in older and younger women. There were no differences in the adjusted complication rates between older and younger patients undergoing implant-based reconstruction. However, older women undergoing autologous reconstruction were more likely to suffer venous thromboembolism (OR, 3.67; p = 0.02). CONCLUSIONS The perioperative risks attributable to breast reconstruction are similar in older and younger women. Older patients should be counseled that their age does not confer an increased risk of complications after implant-based breast reconstruction. However, age is an independent risk factor for venous thromboembolism after autologous reconstruction. Special attention should be paid to venous thromboembolism prophylaxis in this group. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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17
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Ibrahim NB, Anandan S, Hartman AL, McSweeney M, Chun J, McKee A, Yang R, Kim C. Radiographic Findings after Treatment with Balloon Brachytherapy Accelerated Partial Breast Irradiation. Radiographics 2015; 35:6-13. [DOI: 10.1148/rg.351140131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Strader L, Helmer SD, Yates CL, Tenofsky PL. Octogenarians: Noncompliance with Breast Cancer Treatment Recommendations. Am Surg 2014. [DOI: 10.1177/000313481408001127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent research suggests that women older than 70 years of age with early breast cancer who choose lumpectomy may forgo radiation if they take antihormonal medication. However, many elderly patients choose to forgo both radiation and hormonal therapy. This study assessed treatment compliance in elderly patients with breast cancer. A retrospective review was conducted of patients with new-onset breast cancer older than 70 years of age. Patients were stratified by age (70 to 79 vs 80 years or older) and surgical procedure (lumpectomy vs mastectomy). Ninety-seven patients were included; 47 were aged 70 to 79 years, whereas 50 were aged 80 years or older. Treatment recommendations were similar between age groups; however, patients aged 80 years or older were more often noncompliant with recommendations for surgery (14.9 vs 0.0%, P = 0.012), radiation therapy (64.0 vs 16.0%, P = 0.001), and hormonal therapy (53.3 vs 22.6%, P = 0.013). When stratified according to surgical procedure, women aged 80 years or older receiving lumpectomy were overall more noncompliant (50.0 vs 14.8%, P = 0.014) than younger women. Women older than 80 years of age who elected for lumpectomy treatment were significantly less likely to receive standard recommendations of adjuvant hormonal or radiation therapy. The reasons for this vary and it is unknown whether this impacts their local recurrence or survival rate.
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Affiliation(s)
- Lindsaya Strader
- Department of Surgery, The University of Kansas School of Medicine–Wichita, Wichita, Kansas; the
| | - Stephen D. Helmer
- Department of Surgery, The University of Kansas School of Medicine–Wichita, Wichita, Kansas; the
- Department of Medical Education, Via Christi Hospital Saint Francis, Wichita, Kansas; and
| | - Christine L. Yates
- Department of Surgery, The University of Kansas School of Medicine–Wichita, Wichita, Kansas; the
| | - Patty L. Tenofsky
- Department of Surgery, The University of Kansas School of Medicine–Wichita, Wichita, Kansas; the
- Via Christi Clinic, Wichita, Kansas
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19
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Wenaas AE, Nagy CZ, Yiu Y, Xu L, Horter K, Zevallos JP. Demographic and socioeconomic factors predictive of compliance with American Thyroid Association guidelines for the treatment for advanced papillary thyroid carcinoma. Head Neck 2014; 37:1776-80. [PMID: 24986680 DOI: 10.1002/hed.23831] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/05/2014] [Accepted: 06/29/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The American Thyroid Association (ATA) publishes evidence-based guidelines for the treatment of papillary thyroid carcinoma (PTC). We sought to identify factors associated with receiving treatment compliant with the 2006 ATA guidelines for advanced-stage PTC. METHODS The 2006 ATA guideline compliance was examined in patients with stage III and IV PTC extrapolated from Surveillance, Epidemiology, and End Results (SEER). RESULTS Sixty percent of patients received ATA-compliant treatment. A stepwise increase in compliance occurred between 2006 and 2009 (p-value trend = .0003). Age 45 to 64 years versus ≥65 (odds ratio [OR] = 0.682; 95% confidence interval [CI] = 0.57-0.81; p < .0001) and higher income (p trend = .012) were associated with an increased likelihood of receiving ATA-compliant care. African Americans (OR = 0.56; 95% CI = 0.42-0.76; p = .0001) and single patients (OR = 0.81; 95% CI = 0.67-0.97; p = .02) were less likely to receive ATA-compliant care. CONCLUSION This study highlights specific populations at risk for receiving non-ATA-compliant care for PTC and underscores the need to further implement guideline-based practice.
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Affiliation(s)
- Ashley E Wenaas
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Celeste Z Nagy
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Yin Yiu
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Li Xu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelsey Horter
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy. Breast Cancer Res Treat 2014; 145:491-501. [PMID: 24756187 DOI: 10.1007/s10549-014-2968-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
Limited data are available regarding patterns of chemotherapy receipt and treatment-related toxicities for older women receiving adjuvant trastuzumab-based therapy. We used surveillance, epidemiology and end results (SEER)-Medicare data to identify patients ≥66 years with stage I-III breast cancer treated during 2005-2009, who received trastuzumab-based therapy. We examined patterns of chemotherapy receipt, and using multivariable logistic regression, we examined associations of age and comorbidity with non-standard chemotherapy. In propensity-weighted cohorts of women receiving standard and non-standard trastuzumab-based therapy, we also examined rates of (1) hospital events during the first 6 months of chemotherapy and (2) short-term survival. Among 2,106 women, 29.7 % were aged ≥76 and 66 % had a comorbidity score = 0. Overall, 31.3 % of women received non-standard chemotherapy. Compared to patients aged 66-70, older patients more often received non-standard chemotherapy [adjusted odds ratio (OR) = 4.1, 95 % confidence interval (CI) = 3.40-4.92 (ages 76-80); OR = 15.3, 95 %CI = 9.92-23.67 (age ≥ 80)]. However, comorbidity was not associated with receipt of non-standard chemotherapy. After propensity score adjustment, hospitalizations were more frequent in the standard (vs. non-standard) group (adjusted OR = 1.7, 95 % CI = 1.29-2.24). With a median follow-up of 2.8 years, 276 deaths occurred; the adjusted hazard ratio (HR) for death was lower in standard versus non-standard treated women (HR = 0.69, 95 % CI = 0.52-0.91). Among a population-based cohort of older women receiving trastuzumab, nearly one-third received non-standard chemotherapy, with the highest rates among the oldest women. Non-standard chemotherapy was associated with fewer toxicity-related hospitalizations but worse survival. Further exploration of treatment toxicities and outcomes for older women with HER2-positive breast cancer is warranted.
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21
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Javid SH, He H, Korde LA, Flum DR, Anderson BO. Predictors and outcomes of completion axillary node dissection among older breast cancer patients. Ann Surg Oncol 2014; 21:2172-80. [PMID: 24585407 DOI: 10.1245/s10434-014-3595-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND The role of completion axillary lymph node dissection (ALND) for older women who had sentinel lymph node-positive (SLN+) invasive breast cancer is unclear. We examined factors predictive of ALND and the association between ALND, adjuvant chemotherapy administration, and survival. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we reviewed records of women age >65 diagnosed with stage I/II breast cancer from 1998-2005. Adjusted Cox proportional hazards and multivariate logistic regression were used to identify patient and disease variables associated with ALND, and assess association between ALND and all-cause and breast cancer-specific survival. RESULTS Among SLN+ patients, 88 % underwent ALND. Earlier diagnosis year, greater nodal involvement, younger age, registry location, and larger tumor size were all associated with a significantly higher likelihood of ALND. The ALND in SLN+ patients was not significantly associated with 5-year breast cancer-specific survival (hazard ratio [HR] 1.22, 95 % confidence interval [CI] 0.76-1.96). The SLN+ patients who underwent ALND were more likely to receive adjuvant chemotherapy (odds ratio [OR] 1.8, 95 % CI 1.45-2.24). However, younger age (OR 18.0, 95 % CI 14.4-23.9), estrogen receptor-negative (ER-) status (OR 4.2, 95 % CI 3.4-5.3), and fewer comorbidities (OR 2.6, 95 % CI 1.7-4.0) were all more strongly linked to receipt of chemotherapy. CONCLUSIONS ALND for older patients with SLN+ breast cancer is not associated with improved 5-year all-cause or breast cancer-specific survival. Younger age, fewer comorbidities, and estrogen receptor-negative (ER-) status were more strongly associated with receipt of chemotherapy than ALND. Consideration should be given to omitting ALND in older patients, particularly if findings of ALND will not influence adjuvant therapy decisions.
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Affiliation(s)
- Sara H Javid
- Departments of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,
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22
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Lavelle K, Sowerbutts AM, Bundred N, Pilling M, Degner L, Stockton C, Todd C. Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study. Br J Cancer 2014; 110:573-83. [PMID: 24292450 PMCID: PMC3915115 DOI: 10.1038/bjc.2013.734] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/23/2013] [Accepted: 10/30/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Older women have lower breast cancer surgery rates than younger women. UK policy states that differences in cancer treatment by age can only be justified by patient choice or poor health. METHODS We investigate whether lack of surgery for older patients is explained by patient choice/poor health in a prospective cohort study of 800 women aged ≥70 years diagnosed with operable (stage 1-3a) breast cancer at 22 English breast cancer units in 2010-2013. DATA COLLECTION interviews and case note review. OUTCOME MEASURE surgery for operable (stage 1-3a) breast cancer <90 days of diagnosis. Logistic regression adjusts for age, health measures, tumour characteristics, socio-demographics and patient's/surgeon's perceived responsibility for treatment decisions. RESULTS In the univariable analyses, increasing age predicts not undergoing surgery from the age of 75 years, compared with 70-74-year-olds. Adjusting for health measures and choice, only women aged ≥85 years have reduced odds of surgery (OR 0.18, 95% CI: 0.07-0.44). Each point increase in Activities of Daily Living score (worsening functional status) reduced the odds of surgery by over a fifth (OR 0.23, 95% CI: 0.15-0.35). Patient's role in the treatment decisions made no difference to whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive, that is, left the decision up to the surgeon. CONCLUSION Lower surgery rates, among older women with breast cancer, are unlikely to be due to patients actively opting out of having this treatment. However, poorer health explains the difference in surgery between 75-84-year-olds and younger women. Lack of surgery for women aged ≥85 years persists even when health and patient choice are adjusted for.
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Affiliation(s)
- K Lavelle
- School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
| | - A M Sowerbutts
- School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
| | - N Bundred
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
- Nightingale and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - M Pilling
- School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
| | - L Degner
- School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
| | - C Stockton
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
- Nightingale and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK
| | - C Todd
- School of Nursing, Midwifery & Social Work, Jean McFarlane Building, University Place, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
- Manchester Academic Health Sciences Centre (MAHSC), Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
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Roque DR, Cronin B, Robison K, Lopes V, Rizack T, Dizon DS. The effects of age on treatment and outcomes in women with stages IB1-IIB cervical cancer. J Geriatr Oncol 2014; 4:374-81. [PMID: 24472482 DOI: 10.1016/j.jgo.2013.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/28/2013] [Accepted: 07/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Age may affect the treatment choice and subsequent outcome in elderly patients with cervical cancer. Given the potential for cure with either surgery or chemoradiation in early stage disease, we aimed to determine whether a patient's age influenced treatment received and the ensuing outcome. MATERIALS AND METHODS We identified 303 patients with stages IB1-IIB cervical carcinoma treated at our institution between 2000 and 2010, who were divided into two groups based on age at time of diagnosis: < 65 and ≥ 65 years. Adjusted odd ratios were calculated to determine variables associated with treatment received. Single and multivariate Cox proportional hazards modeling were used to estimate hazard ratios (HRs) for variables associated with disease-specific survival. RESULTS Patients were more commonly <65 years at diagnosis (83% versus 17% ≥ 65 years). There was no difference between the two groups in terms of tumor histology, stage at presentation, and grade. Women ≥ 65 years of age were less likely to receive primary surgical management (p=0.03). Age did not influence disease-specific or all-cause mortality. However, women over 65 years who underwent primary surgery were at significantly increased risk of all-cause mortality compared to younger women (HR 6.53, 95% CI: 2.57-16.6). CONCLUSIONS Age appears to influence treatment received by patients with stages IB1-IIB cervical cancer. Although there was no difference in cancer-specific mortality stratified by type of treatment received, surgery was associated with a 6.5-fold increased risk of all-cause mortality among women 65 years or over.
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Affiliation(s)
- Dario R Roque
- The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA.
| | - Beth Cronin
- The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA.
| | - Katina Robison
- The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Program in Women's Oncology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA.
| | - Vrishali Lopes
- Division of Researcxh, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA.
| | - Tina Rizack
- The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Program in Women's Oncology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Medicine, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA.
| | - Don S Dizon
- Medical Gynecologic Oncology Service, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA.
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24
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Tran P, Fentiman IS. Better treatment for breast cancer in older patients. Expert Rev Anticancer Ther 2014; 9:1081-90. [DOI: 10.1586/era.09.67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Abstract
MammoSite is a novel brachytherapy applicator for breast irradiation as a component of breast conservation therapy in the management of early stage breast carcinoma. Early stage breast cancer accounts for over two-thirds of newly diagnosed cases. Breast conservation therapy is an option for most women for local therapy. The standard treatment of partial mastectomy and whole-breast irradiation is being challenged. Physicians and patients are searching for alternatives to a 6- to 7-week course of external beam radiation therapy. The direct application of radioactive materials (brachytherapy) in this setting has been employed for over 10 years. MammoSite has been developed as an easier, more quality assured applicator to allow broader acceptance and wider availability of partial breast irradiation techniques. The background leading to the device will be examined, current clinical results will be reviewed and alternative technologies will be discussed.
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Affiliation(s)
- Martin Keisch
- Mount Sinai Medical Center, Department of Radiation Oncology, Miami Beach, FL 33140, USA.
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26
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Freedman RA, Muss HB. Managing metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the older patient. J Geriatr Oncol 2014; 5:2-7. [DOI: 10.1016/j.jgo.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
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27
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Cloyd JM, Hernandez-Boussard T, Wapnir IL. Poor compliance with breast cancer treatment guidelines in men undergoing breast-conserving surgery. Breast Cancer Res Treat 2013; 139:177-82. [PMID: 23572298 DOI: 10.1007/s10549-013-2517-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 11/28/2022]
Abstract
Lumpectomy is performed in a small but growing proportion of men with breast cancer. It is unknown whether men undergoing breast-conserving surgery (BCS) receive care compliant with breast cancer treatment guidelines. Patients with breast cancer in the surveillance, epidemiology, and end results (SEER) database who underwent lumpectomy between 1983 and 2009 were identified. Gender differences in the receipt of lymph node staging and adjuvant radiation therapy were assessed. Multivariate logistic regression was utilized to evaluate the independent association of gender on these outcomes. The influence of gender on breast cancer-specific survival (BCSS) was analyzed. 382,030 of 824,408 (46.3 %) women compared to 712 of 6,039 (11.8 %) men with breast cancer underwent lumpectomy. Men were older, more likely to be black, less likely to have stage I disease and more likely to have stage IV disease. Only 59.2 % of men had lymph nodes sampled at the time of surgery compared to 81.6 % of women (p < 0.0001). In addition, only 35.4 % of men received adjuvant breast radiation therapy compared to 69.8 % of women (p < 0.0001). After controlling for age, race, stage, grade, and year of diagnosis, female gender was significantly associated with receiving adjuvant radiation therapy (OR 2.9, 95 % CI 2.4-3.4) and lymph node staging (OR 1.6, 95 % CI 1.3-1.90). Five- and ten-year BCSS were 88.0 and 83.5 % for men compared to 93.2 and 88.2 % for women (p < 0.001). Men with breast cancer are less likely to receive lymph node staging or adjuvant radiation therapy following BCS compared to women.
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Affiliation(s)
- Jordan M Cloyd
- Department of Surgery, Stanford University, 300 Pasteur Dr, MC5641, Stanford, CA 94305, USA.
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28
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Roder DM, de Silva P, Zorbas HN, Webster F, Kollias J, Pyke CM, Campbell ID. Adherence to recommended treatments for early invasive breast cancer: decisions of women attending surgeons in the breast cancer audit of Australia and New Zealand. Asian Pac J Cancer Prev 2013; 13:1675-82. [PMID: 22799387 DOI: 10.7314/apjcp.2012.13.4.1675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM The study aim was to determine the frequency with which women decline clinicians' treatment recommendations and variations in this frequency by age, cancer and service descriptors. DESIGN The study included 36,775 women diagnosed with early invasive breast cancer in 1998-2005 and attending Australian and New Zealand breast surgeons. Rate ratios for declining treatment were examined by descriptor, using bilateral and multiple logistic regression analyses. Proportional hazards regression was used in exploratory analyses of associations with breast cancer death. RESULTS 3.4% of women declined a recommended treatment of some type, ranging from 2.6% for women under 40 years to 5.8% for those aged 80 years or more, and with parallel increases by age presenting for declining radiotherapy (p<0.001) and axillary surgery (p=0.006). Multiple regression confirmed that common predictors of declining various treatments included low surgeon case load, treatment outside major city centres, and older age. Histological features suggesting a favourable prognosis were often predictive of declining various treatments, although reverse findings also applied with women with positive nodal status being more likely to decline a mastectomy and those with larger tumours more likely to decline chemotherapy. While survival analyses lacked statistical power due to small numbers, higher risks of breast cancer death were suggested, after adjusting for age and conventional clinical risk factors, (1) for women not receiving breast surgery for unstated reasons (RR=2.29; p<0.001); and (2) although not approaching statistical significance p≥ 0.200), for women declining radiotherapy (RR=1.22), a systemic therapy (RR1.11), and more specifically, chemotherapy (RR=1.41). CONCLUSIONS Women have the right to choose their treatments but reasons for declining recommendations require further study to ensure that choices are well informed and clinical outcomes are optimized.
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Affiliation(s)
- David M Roder
- Cancer Australia; Cancer Epidemiology, University of South Australia
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29
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Sacerdote C, Bordon R, Pitarella S, Mano MP, Baldi I, Casella D, Di Cuonzo D, Frigerio A, Milanesio L, Merletti F, Pagano E, Ricceri F, Rosso S, Segnan N, Tomatis M, Ciccone G, Vineis P, Ponti A. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy. BMC Health Serv Res 2013; 13:28. [PMID: 23351327 PMCID: PMC3566978 DOI: 10.1186/1472-6963-13-28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/15/2013] [Indexed: 12/03/2022] Open
Abstract
Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL) for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL) and 621 in 2004 (post-PGL). Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368) and 77.5% (N = 383) in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS) as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268) and 63.6% (N = 252) received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%). The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10) among the 92 estrogen receptor-negative patients in 2004 (p < 0.01). Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14 reached statistical significance. We did not find any change in the risk of mortality in the post-PGL versus the pre-PGL group (adjusted hazard ratio 0.94, 95%CI 0.56–1.56). Conclusions These results highlight the need to continue to improve breast cancer care and to measure adherence to PGL.
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Affiliation(s)
- Carlotta Sacerdote
- Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy.
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30
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Sanpaolo P, Barbieri V, Genovesi D, Fusco V, Ausili Cèfaro G, Audisio RA. Patients younger than 40years old and older than 70years old affected by ER(−)/PR(−)/HER2(−) breast cancer have low survival rates: Results of a mono-institutional retrospective analysis. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.06.001] [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]
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31
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Lavelle K, Downing A, Thomas J, Lawrence G, Forman D, Oliver SE. Are lower rates of surgery amongst older women with breast cancer in the UK explained by co-morbidity? Br J Cancer 2012; 107:1175-80. [PMID: 22878370 PMCID: PMC3461147 DOI: 10.1038/bjc.2012.192] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/12/2012] [Accepted: 04/14/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Around 60% of women ≥ 80 years old, in the UK do not have surgery for their breast cancer (vs<10% of younger age groups). The extent to which this difference can be accounted for by co-morbidity has not been established. METHODS A Cancer Registry/Hospital Episode Statistics-linked data set identified women aged ≥ 65 years diagnosed with invasive breast cancer (between 1 April 1997 and 31 March 2005) in two regions of the UK (n=23038). Receipt of surgery by age was investigated using logistic regression, adjusting for co-morbidity and other patient, tumour and treatment factors. RESULTS Overall, 72% of older women received surgery, varying from 86% of 65-69-year olds to 34% of women aged ≥ 85 years. The proportion receiving surgery fell with increasing co-morbidity (Charlson score 0=73%, score 1=66%, score 2+=49%). However, after adjustment for co-morbidity, older age still predicts lack of surgery. Compared with 65-69-year olds, the odds of surgery decreased from 0.74 (95% CI: 0.66-0.83) for 70-74-year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥ 85 years. CONCLUSION Although co-morbidity is associated with a reduced likelihood of surgery, it does not explain the shortfall in surgery amongst older women in the UK. Routine data on co-morbidity enables fairer comparison of treatment across population groups but needs to be more complete.
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Affiliation(s)
- K Lavelle
- School of Nursing, Midwifery and Social Work, The University of Manchester, 5.332 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
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Berglund A, Wigertz A, Adolfsson J, Ahlgren J, Fornander T, Wärnberg F, Lambe M. Impact of comorbidity on management and mortality in women diagnosed with breast cancer. Breast Cancer Res Treat 2012; 135:281-9. [PMID: 22829398 DOI: 10.1007/s10549-012-2176-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/17/2012] [Indexed: 11/29/2022]
Abstract
To investigate associations between comorbidity burden, management, and mortality in women with breast cancer. A total of 42,646 women diagnosed with breast cancer between 1992 and 2008 were identified in two Clinical Quality Registers in Central Sweden. Breast cancer-specific, conditional breast cancer, competing-cause and all-cause mortality were estimated in relation to comorbidity burden assessed by the Charlson comorbidity index. All analyses were stratified by stage at diagnosis using competing risk analyses, and all-cause mortality was estimated as a function of follow-up time. Following adjustment for age and calendar period, breast conserving surgery was significantly less likely to be offered to women with severe comorbidity (OR 0.63; 95 % CI 0.58-0.69). Similarly, the proportion treated with radiotherapy, tamoxifen, or chemotherapy was lower in women with severe compared to those with no comorbidity. In women with early stage disease, breast cancer-specific mortality was higher among patients with severe comorbidity (sHR 1.47; 95 % CI 1.11-1.94). In all stages of breast cancer, conditional breast cancer and competing-cause mortality were elevated in women with severe comorbidity. For all stages, the relative risk of all-cause mortality between women with severe versus no comorbidity varied by time since diagnosis, and was most pronounced at early follow-up. Comorbidity affects treatment decisions and mortality. In women with early stage breast cancer, severe comorbidity was associated not only with conditional breast cancer, competing-cause and all-cause mortality, but also breast cancer-specific mortality. The observed differences in breast cancer-specific mortality may be due to less extensive treatment, impaired tumor defense and differences in general health status and lifestyle factors.
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Affiliation(s)
- Anders Berglund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77 Stockholm, Sweden.
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Pignol JP, Rakovitch E, Zeppieri J, Hanna W. Accuracy and Completeness of Pathology Reporting — Impact on Partial Breast Irradiation Eligibility. Clin Oncol (R Coll Radiol) 2012; 24:177-82. [DOI: 10.1016/j.clon.2011.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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Oladipo O, Coyle V, McAleer JJ, McKenna S. Achieving Optimal Dose Intensity with Adjuvant Chemotherapy in Elderly Breast Cancer Patients: A 10-Year Retrospective Study in a UK Institution. Breast J 2011; 18:16-22. [DOI: 10.1111/j.1524-4741.2011.01177.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Ladoire S, Rambach L, Quipourt V, Favier L, Ghiringhelli F, Arnould L, Pfitzenmeyer P, Fumoleau P, Coudert B. Feasibility and Safety of Weekly Sequential Epirubicin-Paclitaxel as Adjuvant Treatment for Operable Breast Cancer Patients Older than 70 Years. Clin Breast Cancer 2011; 11:235-40. [DOI: 10.1016/j.clbc.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/19/2010] [Accepted: 12/01/2010] [Indexed: 11/28/2022]
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Weggelaar I, Aben KK, Warlé MC, Strobbe LJ, van Spronsen DJ. Declined guideline adherence in older breast cancer patients: a population-based study in the Netherlands. Breast J 2011; 17:239-45. [PMID: 21477166 DOI: 10.1111/j.1524-4741.2011.01074.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Older women with primary operable breast cancer might receive suboptimal care due to their advanced age. Although several studies reported age as an independent determinant for receiving none or less treatment according to accepted standards, prospective data are lacking. This study evaluates the adherence to a consensus protocol in unselected women aged 80 years and older in the Netherlands. Data were derived from the Dutch population-based Cancer Registry held by the Comprehensive Cancer Centre East. In this study all female patients, 60 years and older, diagnosed with breast cancer TNM stage I-IIIa in the period 2001 until 2006 were selected. Applied treatment according to the Dutch guideline was compared for different age groups. Differences between age groups were evaluated using a chi-square test. In total, 2336 breast cancer patients were studied. Treatment adherence was significantly lower for surgery, radiation therapy and systemic therapy in women aged 80 years and older, and all modalities were applied much less frequently, except for endocrine therapy which was more frequently applied in the oldest old. This study shows a sharp decline in guideline adherence for unselected women aged 80 years and older with primary operable breast cancer, with an observed shift from appropriate locoregional treatment toward endocrine therapy. Whether this approach is justified or not should preferably be tested prospectively.
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Affiliation(s)
- Ines Weggelaar
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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37
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Dooley WC, Algan O, Dowlatshahi K, Francescatti D, Tito E, Beatty JD, Lerner AG, Ballard B, Boolbol SK. Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy for the treatment of breast cancer. World J Surg Oncol 2011; 9:30. [PMID: 21385371 PMCID: PMC3065420 DOI: 10.1186/1477-7819-9-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 03/07/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed post-lumpectomy in eligible patients with breast cancer. Patient and tumor characteristics as well as the lumpectomy technique can influence patient eligibility for APBI. This report describes a lumpectomy procedure and examines patient, tumor, and surgical characteristics from a prospective, multicenter study of electronic brachytherapy. METHODS The study enrolled 65 patients of age 45-84 years with ductal carcinoma or ductal carcinoma in situ, and 44 patients, who met the inclusion and exclusion criteria, were treated with APBI using the Axxent® electronic brachytherapy system following lumpectomy. The prescription dose was 34 Gy in 10 fractions over 5 days. RESULTS The lumpectomy technique as described herein varied by site and patient characteristics. The balloon applicator was implanted by the surgeon (91%) or a radiation oncologist (9%) during or up to 61 days post-lumpectomy (mean 22 days). A lateral approach was most commonly used (59%) for insertion of the applicator followed by an incision site approach in 27% of cases, a medial approach in 5%, and an inferior approach in 7%. A trocar was used during applicator insertion in 27% of cases. Local anesthetic, sedation, both or neither were administered in 45%, 2%, 41% and 11% of cases, respectively, during applicator placement. The prescription dose was delivered in 42 of 44 treated patients. CONCLUSIONS Early stage breast cancer can be treated with breast conserving surgery and APBI using electronic brachytherapy. Treatment was well tolerated, and these early outcomes were similar to the early outcomes with iridium-based balloon brachytherapy.
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MESH Headings
- Aged
- Aged, 80 and over
- Brachytherapy/methods
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Prospective Studies
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Affiliation(s)
- William C Dooley
- University of Oklahoma Health Sciences Center, 825 NE 10th Street Suite 4500, Oklahoma City, OK 73104, USA
| | - Ozer Algan
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 825 North East 10th Street Suite 1430, Oklahoma City, OK 73104, USA
| | - Kambiz Dowlatshahi
- Rush University Medical Center, 60 E Delaware Place Suite 1400, Chicago, IL 60611, USA
| | - Darius Francescatti
- Rush University Medical Center, 1725 West Harrison Street Suite 810, Chicago, IL 60612, USA
| | - Elizabeth Tito
- Rhode Island Hospital, Providence, RI 02903, USA
- Enterprise Surgical, 91 Washington St Unit 302, Taunton, MA 02780, USA
| | - J David Beatty
- Swedish Cancer Institute, Comprehensive Breast Center, Swedish Medical Center, 1600 East Jefferson St. Suite 305, Seattle, WA 98122, USA
| | - Art G Lerner
- Dickstein Cancer Center, White Plains Hospital, White Plains, 4 Longview Ave, NY 10601, USA
| | - Betsy Ballard
- Holy Cross Medical Center, 2101 Medical Parks Drive Suite 304, Silver Spring, MD 20902, USA
| | - Susan K Boolbol
- Beth Israel Medical Center, 10 Union Square East, New York City, NY 10003, USA
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38
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Early primary breast cancer in the elderly – Pattern of presentation and treatment. Surg Oncol 2011; 20:7-12. [DOI: 10.1016/j.suronc.2009.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 11/20/2022]
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Ali AMG, Greenberg D, Wishart GC, Pharoah P. Patient and tumour characteristics, management, and age-specific survival in women with breast cancer in the East of England. Br J Cancer 2011; 104:564-70. [PMID: 21326244 PMCID: PMC3049594 DOI: 10.1038/bjc.2011.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Breast cancer relative survival (BCRS), which compares the observed survival of women with breast cancer with the expected survival of women for the whole population of the same age, time period, and geographical region, tends to be poorer in older women, but the reasons for this are not clear. We examined the influence of patient and tumour characteristics, and treatment on BCRS to see whether these could explain the age-specific effect. METHODS Data for 14,048 female breast cancer patients diagnosed from 1999 to 2007, aged 50 years or over were obtained from the Eastern Cancer Registration and Information Centre. We estimated relative 5- and 10-year survival for patients in four age groups (50-69, 70-74, 75-79, and 80+ years). We also modelled relative excess mortality (REM) rate using Poisson regression adjusting for patient characteristics and treatment. The REMs derived from these models quantify the extent to which the hazard of death differs from the hazard in the reference category, after taking into account the background risk of death in the general population. We compared the results with those obtained for breast cancer-specific mortality, analysed using multivariate Cox regression. RESULTS Median follow-up time was 4.7 years. Relative 5-year survival was 89, 81, 76, and 70% for patients aged 50-69, 70-74, 75-79, and 80+ years, respectively. Corresponding relative 10-year survival was 84, 77, 67, and 66%. Unadjusted REM was 1.93, 2.74, and 3.88 for patients aged 70-74, 75-79, and 80+ years, respectively, (50-69 years as reference). The equivalent hazard ratios from the Cox model were 1.88, 2.45, and 3.81. These were attenuated after adjusting for confounders (REM - 1.49, 1.36, and 1.23; Cox - 1.47, 1.50, and 1.76). CONCLUSION We confirmed poorer BCRS in older women in our region. This was partially explained by known prognostic factors. Further research is needed to determine whether biological differences or suboptimal management can explain the residual excess mortality.
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Affiliation(s)
- A M G Ali
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK,E-mail:
| | - D Greenberg
- Eastern Cancer Registration and Information Centre, Cambridge, UK
| | - G C Wishart
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK,Department of Oncology, University of Cambridge, Cambridge, UK
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Breast cancer care compared with clinical Guidelines: an observational study in France. BMC Public Health 2011; 11:45. [PMID: 21251274 PMCID: PMC3037311 DOI: 10.1186/1471-2458-11-45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 01/20/2011] [Indexed: 11/18/2022] Open
Abstract
Background Great variability in breast cancer (BC) treatment practices according to patient, tumour or organisation of care characteristics has been reported but the relation between these factors is not well known. In two French regions, we measured compliance with Clinical Practice Guidelines for non-metastatic BC care management and identified factors associated with non-compliance at clinical and organisational levels. Methods Eligible patients had invasive unilateral BC without distant metastases and at least two contacts with one of the two regional healthcare systems (2003-2004) in the first year after diagnosis. Medical data were collected from patient medical records in all public and private hospitals (99 hospitals). The care process was defined by 20 criteria: clinical decisions for treatment and therapeutic procedures. Each criterion was classified according to level of compliance ("Compliant", "Justifiable" and "Not Compliant") and factors of non-compliance were identified (mixed effect logistic regression). Results 926 women were included. Non-compliance with clinical decisions for treatment was associated with older patient age (OR 2.1; 95%CI: 1.3-3.6) and region (OR 3.0; 95%CI: 1.2-7.4). Non-compliance with clinical decisions for radiotherapy was associated with lymph node involvement or the presence of peritumoural vascular invasion (OR 1.5; 95%CI: 1.01-2.3) and non-compliance with overall treatment (clinical decisions for treatment + therapeutic procedures) was associated with the presence of positive lymph nodes (OR 2.0; 95%CI: 1.2-3.3), grade III versus grade I (OR 2.9; 95%CI: 1.4-6.2), and one region of care versus another (OR 3.5; 95%CI: 1.7-7.1). Finally, heterogeneity of compliance in overall treatment sequence was identified between local cancer units (p < 0.05). Conclusion This study provides interesting insights into factors of non-compliance in non-metastatic BC management and could lead to quality care improvements.
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Saxena N, Hartman M, Hussain Z, Pathy NB, Iau P, Lee SC, Lee KM, Lim SE, Wong JE, Verkooijen HM. Impact of older age on presentation, management and outcome of breast cancer in the multi-ethnic Asian population of Singapore. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The U.S. population is now healthier and more long-lived than ever, and the average life expectancy for a woman born today is about 80 years. An elderly woman's life expectancy, which is related to comorbidity and functional status, is particularly important when determining the appropriate choice of adjuvant chemotherapy and endocrine therapy. In addition, the disease stage and the tumor's biologic characteristics (grade and hormone/human epidermal growth factor [HER]-2 receptor status) must be considered when formulating a treatment plan for 3 clinically distinctive breast cancer subgroups: (1) hormone receptor negative (HR-) and HER-2 negative ("triple-negative" tumors, about 15% of older patients); (2) hormone receptor positive (HR+) and HER-2 negative (the largest group comprising about 70% of older patients); and (3) HER-2 positive irrespective of HR status (about 15% of older patients). The functional status of an older woman can be estimated by a Comprehensive Geriatric Assessment (CGA). A traditional CGA is time consuming, but testing of shorter, validated CGA instruments is ongoing. Monitoring toxicity in the elderly is especially important because even low-grade toxicity can have a significant effect on function. Eligible older women should be considered for state-of-the-art treatment, including clinical trials to determine the optimal adjuvant regimens for this patient population and how the therapies affect the woman's functioning and quality of life.
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Determinants of outcome in elderly patients with positive sentinel lymph nodes. Am J Surg 2010; 201:734-40. [PMID: 20619395 DOI: 10.1016/j.amjsurg.2010.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/23/2010] [Accepted: 02/15/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Older women are less likely to receive standard of care treatment for breast cancer. METHODS We examined variables that affected the outcome of elderly patients ≥70 years old among 1,470 patients with invasive cancer with positive sentinel lymph nodes (SLNs). RESULTS Elderly patients were less likely to undergo mastectomy, completion axillary node dissection (ALND), adjuvant chemotherapy, and radiotherapy (RT) following breast-conserving therapy (BCT) compared with patients <70 years old. The 5-year risk of disease progression and cumulative incidence of breast cancer-specific deaths were not significantly different for both groups. On multivariate analysis, hormone receptor-negative status, number of metastatic lymph nodes, high nuclear grade, and tumor size were the factors independently associated with increased risk of disease progression. CONCLUSIONS Tumor factors were the primary determinants of breast cancer outcomes in our cohort. Elderly patients are less likely to receive aggressive surgical interventions and adjuvant therapy because of perceived life expectancy.
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Yeo SG, Kim J, Kwak GH, Kim JY, Park K, Kim ES, Han S. Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity. Radiat Oncol 2010; 5:56. [PMID: 20565899 PMCID: PMC2905428 DOI: 10.1186/1748-717x-5-56] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 06/19/2010] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer. Methods Between 2002 and 2006, 48 prospectively selected patients with early-stage breast cancer received APBI using multicatheter brachytherapy following breast-conserving surgery. Their median age was 52 years (range 36-78). A median of 34 Gy (range 30-34) in 10 fractions given twice daily within 5 days was delivered to the tumor bed plus a 1-2 cm margin. Most (92%) patients received adjuvant systemic treatments. The median follow-up was 53 months (range 36-95). Actuarial local control rate was estimated from surgery using Kaplan-Meier method. Results Local recurrence occurred in two patients. Both were true recurrence/marginal miss and developed in patients with close (< 0.2 cm) surgical margin after 33 and 40 months. The 5-year actuarial local recurrence rate was 4.6%. No regional or distant relapse and death has occurred to date. Late Grade 1 or 2 late skin and subcutaneous toxicity was seen in 11 (22.9%) and 26 (54.2%) patients, respectively. The volumes receiving 100% and 150% of the prescribed dose were significantly higher in the patients with late subcutaneous toxicity (p = 0.018 and 0.034, respectively). Cosmesis was excellent to good in 89.6%. Conclusions APBI using HDR multicatheter brachytherapy yielded local control, toxicity, and cosmesis comparable to those of conventional whole breast irradiation for select early-stage breast cancer. Patients with close resection margins may be ineligible for APBI.
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Affiliation(s)
- Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Korea.
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Ahmed HM, DiPiro PJ, Devlin PM, Nguyen ML, Bellon JR. Mammographic Appearance Following Accelerated Partial Breast Irradiation by Using MammoSite Brachytherapy. Radiology 2010; 255:362-8. [DOI: 10.1148/radiol.10091625] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 2010; 28:2038-45. [PMID: 20308658 PMCID: PMC2860406 DOI: 10.1200/jco.2009.25.9796] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. PATIENTS AND METHODS We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, > or = 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer-related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age > or = 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age > or = 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). CONCLUSION Women age > or = 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.
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Affiliation(s)
- Mara A Schonberg
- Beth Israel Deaconess Medical Center, 1309 Beacon, Office 202, Brookline, MA 02446, USA.
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Kotsori AA, Noble JL, Ashley S, Johnston S, Smith IE. Moderate dose capecitabine in older patients with metastatic breast cancer: a standard option for first line treatment? Breast 2010; 19:377-81. [PMID: 20392643 DOI: 10.1016/j.breast.2010.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 03/13/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022] Open
Abstract
Single agent capecitabine is effective and well tolerated in metastatic breast cancer (MBC). We have retrospectively analysed capecitabine outcome as 1st, 2nd or 3rd line chemotherapy in 89 elderly patients ≥70 years with locally advanced or MBC treated in our Unit, 55 (62%) as 1st line and 34 (38%) as 2nd or 3rd line. Starting dose was 1000 mg/m(2) twice daily, days 1-14 every 3 weeks, but 36 (41%) started on a 25% dose reduction because of frailty and 12 (13%) reduced dose after the 1st or the 2nd cycle. Overall response rate (ORR) was 45% (95% CI: 35-55%). A further 19 (21%) achieved stable disease (SD) for ≥6 months. Median time to progression (TTP) and overall survival (OS) were 30 (95% CI: 23-37) and 61 (95% CI: 44-77) weeks, respectively. The ORR for 1st line treatment was 51% compared with 35% for 2nd and 3rd line treatment (p = 0.03). No significant difference in efficacy was seen between patients receiving the full versus reduced dose. Capecitabine was well tolerated, although 35% had treatment delays and 57% required dose reduction. Grade 3-4 toxicities were hand-foot syndrome in 11%, lethargy 9% and diarrhoea 2%. Capecitabine is an effective and well-tolerated drug in elderly patients with MBC including for 1st line treatment. Dose reduction is frequently required but does not appear to affect outcome.
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Affiliation(s)
- A A Kotsori
- Breast Unit RMH and Institute of Cancer Research, Fulham Road, London, United Kingdom.
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Hancke K, Denkinger MD, König J, Kurzeder C, Wöckel A, Herr D, Blettner M, Kreienberg R. Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Oncol 2010; 21:748-753. [PMID: 19825884 DOI: 10.1093/annonc/mdp364] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Hancke
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm.
| | - M D Denkinger
- Geriatric Department, Bethesda Geriatric Clinic, University of Ulm, Ulm
| | - J König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - C Kurzeder
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - A Wöckel
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - D Herr
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
| | - M Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - R Kreienberg
- Department of Obstetrics and Gynecology, University of Ulm Medical School, Ulm
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Cutuli B, De Lafontan B, Vitali E, Costa L, Aristei C, Marchal C, Quetin P, Fay R. Breast conserving treatment (BCT) for stage I–II breast cancer in elderly women: Analysis of 927 cases. Crit Rev Oncol Hematol 2009; 71:79-88. [DOI: 10.1016/j.critrevonc.2008.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 09/16/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022] Open
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Mutyala S, Yaparpalvi R, Choi W, Mehta K, Spierer M, Kalnicki S. Placement of MammoSite brachytherapy catheter under computed-tomography scan guidance. Technol Cancer Res Treat 2009; 8:177-80. [PMID: 19445534 DOI: 10.1177/153303460900800301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Placement of the MammoSite breast brachytherapy catheter is most commonly performed either intraoperatively or under ultrasound-guided technique. Below, we present a case report of an alternate approach utilizing CT-scan guidance. This is the first reported case of a balloon brachytherapy catheter placement with this technique.
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Affiliation(s)
- S Mutyala
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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