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Wirth K, Näpflin M, Graber SM, Blozik E. Does hospital volume affect outcomes after abdominal cancer surgery: an analysis of Swiss health insurance claims data. BMC Health Serv Res 2022; 22:262. [PMID: 35219332 PMCID: PMC8881861 DOI: 10.1186/s12913-022-07513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Medical treatment quality has been shown to be better in high volume than in low volume hospitals. However, this relationship has not yet been confirmed in abdominal cancer in Switzerland and is relevant for referral of patients and healthcare planning. Thus, the present study investigates the association between hospital volumes for surgical resections of colon, gastric, rectal, and pancreatic carcinomas and outcomes. Methods This retrospective analysis is based on anonymized claims data of patients with mandatory health insurance at Helsana Group, a leading health insurance in Switzerland. Outcome parameters were length of hospital stay, mortality and cost during the inpatient stay as well as at 1-year follow-up. Hospital volume information was derived from the Quality Indicators dataset provided by the Swiss Federal Office of Public Health. The impact of hospital volume on the different treatment outcomes was statistically tested using generalized estimating equations (GEE) models, taking into account the non-independence of observations from the same hospital. Results The studies included 2′859 resections in patients aged 18 years and older who were hospitalized for abdominal cancer surgery between 2014 and 2018. Colon resections were the most common procedures (n = 1′690), followed by rectal resections (n = 709). For rectal, colon and pancreatic resections, an increase in the mean number of interventions per hospital and a reduction of low volume hospitals could be observed. For the relationship between hospital volume and outcomes, we did not observe a clear dose-response relationship, as no significantly better outcomes were observed in the higher-volume category than in the lower-volume category. Even though a positive “routine effect” cannot be excluded, our results suggest that even hospitals with low volumes are able to achieve comparable treatment outcomes to larger hospitals. Conclusion In summary, this study increases transparency on the relationship between hospital volume and treatment success. It shows that simple measures such as defining a minimum number of procedures only might not lead to the intended effects if other factors such as infrastructure, the operating team or aggregation level of the available data are not taken into account. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07513-5.
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Ess SM, Herrmann C, Bouchardy C, Neyroud I, Rapiti E, Konzelmann I, Bordoni A, Ortelli L, Rohrmann S, Frick H, Mousavi M, Thürlimann B. Impact of subtypes and comorbidities on breast cancer relapse and survival in population-based studies. Breast 2018; 41:151-158. [DOI: 10.1016/j.breast.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/11/2018] [Accepted: 07/29/2018] [Indexed: 12/20/2022] Open
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Dasgupta P, Baade PD, Youlden DR, Garvey G, Aitken JF, Wallington I, Chynoweth J, Zorbas H, Youl PH. Variations in outcomes by residential location for women with breast cancer: a systematic review. BMJ Open 2018; 8:e019050. [PMID: 29706597 PMCID: PMC5935167 DOI: 10.1136/bmjopen-2017-019050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN Systematic review. METHODS Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny R Youlden
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | - Helen Zorbas
- Cancer Australia, Sydney, New South Wales, Australia
| | - Philippa H Youl
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- None, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Ess S, Herrmann C, Frick H, Krapf M, Cerny T, Jochum W, Früh M. Epidermal growth factor receptor and anaplastic lymphoma kinase testing and mutation prevalence in patients with advanced non-small cell lung cancer in Switzerland: A comprehensive evaluation of real world practices. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12721] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S.M. Ess
- Cancer Registry St. Gallen-Appenzell; Cancer League Eastern Switzerland; St. Gallen Switzerland
| | - C. Herrmann
- Cancer Registry St. Gallen-Appenzell; Cancer League Eastern Switzerland; St. Gallen Switzerland
- Department of Public Health; University of Basel; Basel Switzerland
- Swiss Tropical and Public Health Institute; Basel Switzerland
| | - H. Frick
- Cancer Registry St. Gallen-Appenzell; Cancer League Eastern Switzerland; St. Gallen Switzerland
| | - M. Krapf
- Cancer Registry St. Gallen-Appenzell; Cancer League Eastern Switzerland; St. Gallen Switzerland
- University of Bern; Bern Switzerland
| | - T. Cerny
- Department of Internal Medicine; Division Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - W. Jochum
- Institute of Pathology; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - M. Früh
- Department of Internal Medicine; Division Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
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Baade PD, Dasgupta P, Youl PH, Pyke C, Aitken JF. Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997-2011: Improvements over Time but Inequalities Remain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E729. [PMID: 27447656 PMCID: PMC4962270 DOI: 10.3390/ijerph13070729] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022]
Abstract
The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%). After adjustment for socio-demographic and clinical factors, compared to women living in very high accessibility areas, women in high (Odds Ratio (OR) 0.58 (95% confidence intervals (CI) 0.49, 0.69)), low (OR 0.47 (0.41, 0.54)) and very low (OR 0.44 (0.34, 0.56)) accessibility areas had lower odds of having BCS, while the odds for women from middle (OR 0.81 (0.69, 0.94)) and most disadvantaged (OR 0.87 (0.71, 0.98)) areas was significantly lower than women living in affluent areas. The association between accessibility and the type of surgery reduced over time (interaction p = 0.028) but not for area disadvantage (interaction p = 0.209). In making informed decisions about surgical treatment, it is crucial that any geographical-related barriers to implementing their preferred treatment are minimised.
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Affiliation(s)
- Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
| | - Paramita Dasgupta
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
| | - Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia.
- School of Population Health, University of Queensland, Brisbane 4006, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba 4350, Australia.
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Matter-Walstra KW, Achermann R, Rapold R, Klingbiel D, Bordoni A, Dehler S, Konzelmann I, Mousavi M, Clough-Gorr KM, Szucs T, Schwenkglenks M, Pestalozzi BC. Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09). Eur J Cancer Care (Engl) 2016; 26. [PMID: 26856977 DOI: 10.1111/ecc.12453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/28/2022]
Abstract
Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established.
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Affiliation(s)
- K W Matter-Walstra
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.,Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R Achermann
- (Formerly) Helsana Group, Dübendorf, Switzerland
| | - R Rapold
- (Formerly) Helsana Group, Dübendorf, Switzerland
| | - D Klingbiel
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A Bordoni
- Cancer Registry Ticino, Instituto cantonale di patologia, Locarno, Switzerland
| | - S Dehler
- Cancer Registry Zürich and Zug, University Hospital Zürich, Zürich, Switzerland
| | - I Konzelmann
- Cancer Registry Valais, Observatoire valaisan de la santé, Sion, Switzerland
| | - M Mousavi
- Cancer Registry Basel, Gesundheitsdienste Projekte & Service, Basel, Switzerland
| | - K M Clough-Gorr
- Institute for Social and Preventative Medicine (ISPM), University of Bern, Bern, Switzerland
| | - T Szucs
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.,(Formerly) Helsana Group, Dübendorf, Switzerland
| | - M Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - B C Pestalozzi
- Department Oncology, University Hospital Zürich, Zürich, Switzerland
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Variations in compliance to quality indicators by age for 41,871 breast cancer patients across Europe: A European Society of Breast Cancer Specialists database analysis. Eur J Cancer 2015; 51:1221-30. [DOI: 10.1016/j.ejca.2015.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/26/2015] [Accepted: 03/14/2015] [Indexed: 11/24/2022]
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Fizazi K, Abrahamsson PA, Ahlgren G, Bellmunt J, Castellano D, Culine S, de Wit R, Gillessen S, Gschwend JE, Hamdy F, James N, McDermott R, Miller K, Wiegel T, Wirth M, Tombal B. Achievements and perspectives in prostate cancer phase 3 trials from genitourinary research groups in Europe: introducing the Prostate Cancer Consortium in Europe. Eur Urol 2014; 67:904-12. [PMID: 25218582 DOI: 10.1016/j.eururo.2014.08.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/29/2014] [Indexed: 12/19/2022]
Abstract
CONTEXT Phase 3 trials have made major contributions to advances in prostate cancer (PCa). However, funding limitations and excess bureaucracy are now making it difficult to conduct trials. OBJECTIVE To describe the collaborative groups in Europe and their academic phase 3 PCa trials. EVIDENCE ACQUISITION Leaders of collaborative groups from Scandinavia, the European Organisation for Research and Treatment of Cancer (EORTC), France, Spain, the United Kingdom, Germany, Switzerland, The Netherlands, and Ireland were asked to provide information. EVIDENCE SYNTHESIS Approximately 40 academic European phase 3 trials focussing on PCa have been completed, and about 10 are accruing patients. Cross-border trials have been successfully conducted led by EORTC (11), Scandinavian Prostate Cancer Group (9), European Association of Urology (1), Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficiency (STAMPEDE) (1), and the French Genito-Urinary Tumor Group (1). Among these studies were practise-changing trials showing the superiority of prostatectomy over watchful waiting in patients <65 yr of age, the benefits of combining androgen-deprivation therapy (ADT) with radiation therapy (RXT) in high-risk localised disease, the superiority of long-term versus short-term ADT, the benefit of RXT in men treated with ADT, and the role of adjuvant RXT. To bridge the numbers gap for phase 3 studies, the Prostate Cancer Consortium in Europe (PEACE) is a recently established initiative that aims to favour cross-border networks of investigators. PEACE 1 is testing the addition of abiraterone and that of RXT directed at the primary cancer in patients with de novo metastatic PCa treated with ADT. PEACE 2 is testing the addition of cabazitaxel and that of pelvic irradiation in patients with at least two criteria for high-risk localised PCa. CONCLUSIONS European academic phase 3 trials have contributed to establishing the current standard treatment of PCa. The PEACE consortium was recently tasked with the goal of addressing unanswered questions and specific biology-related issues more efficiently. PATIENT SUMMARY The Prostate Cancer Consortium in Europe was established to conduct comparative trials aiming at assessing new treatments for prostate cancer patients.
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Affiliation(s)
- Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France.
| | - Per-Anders Abrahamsson
- Department of Urology, Lund University, Lund, Sweden, and Malmö University, Malmö, Sweden
| | - Goran Ahlgren
- Department of Urology, Lund University, Lund, Sweden, and Malmö University, Malmö, Sweden
| | - Joaquim Bellmunt
- Department of Medical Oncology, University Hospital del Mar, UPF University, Barcelona, Spain
| | - Daniel Castellano
- Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Stephane Culine
- Department of Medical Oncology, Hôpital Saint Louis, Paris, France
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - Silke Gillessen
- Department of Medical Oncology, Kantonsspital, St. Gallen, Switzerland
| | - Juergen E Gschwend
- Urologische Klinik und Poliklinik der Technischen Universität, München, Germany
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicholas James
- Cancer Research Unit, University of Warwick, Coventry, UK
| | - Raymond McDermott
- Department of Medical Oncology, The Adelaide and Meath Hospital, Dublin, Ireland
| | - Kurt Miller
- Klinik für Urologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Manfred Wirth
- Department of Urology, University Clinic Carl Gustav Carus, Dresden, Germany
| | - Bertrand Tombal
- Service d'Urologie, Institut de Recherche Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Joerger M, Thürlimann B, Savidan A, Frick H, Rageth C, Lütolf U, Vlastos G, Bouchardy C, Konzelmann I, Bordoni A, Probst-Hensch N, Jundt G, Ess S. Treatment of breast cancer in the elderly: a prospective, population-based Swiss study. J Geriatr Oncol 2012; 4:39-47. [PMID: 24071491 DOI: 10.1016/j.jgo.2012.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/16/2012] [Accepted: 08/03/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The primary objective of this population-based study is to describe the patterns of care of elderly patients with breast cancer (BC), and evaluate potential causative factors for the decrease in BC-specific survival (BCSS) in the elderly. PATIENTS AND METHODS We included all or representative samples of patients with newly diagnosed BC from seven Swiss cancer registries between 2003 and 2005 (n=4820). Surgical and non-surgical BC treatment was analyzed over 5 age groups (<65, 65 to <70, 70 to <75, 75 to <80 and ≥80years), and the predictive impact of patient age on specific treatments was calculated using multivariate logistic regression analysis. RESULTS The proportion of locally advanced, metastatic and incompletely staged BC increased with age. The odds ratio for performing breast-conserving surgery (BCS) in stages I-II BC (0.37), sentinel lymph node dissection (SLND) in patients with no palpable adenopathy (0.58), post-BCS radiotherapy (0.04) and adjuvant endocrine treatment (0.23) were all in disfavor of patients ≥80years of age compared to their younger peers. Only 36% of patients ≥80years of age with no palpable adenopathy underwent SLND. In the adjusted model, higher age was a significant risk factor for omitting post-BCS radiotherapy, SLND and adjuvant endocrine treatment. CONCLUSIONS This study found an increase in incomplete diagnostic assessment, and a substantial underuse of BCS, post-BCS radiotherapy, SLND and adjuvant endocrine treatment in elderly patients with BC. There is a need for improved management of early BC in the elderly even in a system with universal access to health care services.
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Affiliation(s)
- M Joerger
- Cancer Registry St. Gallen-Appenzell, St.Gallen, Switzerland; Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland.
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Joerger M, Thürlimann B, Savidan A, Frick H, Bouchardy C, Konzelmann I, Probst-Hensch N, Ess S. A Population-Based Study on the Implementation of Treatment Recommendations for Chemotherapy in Early Breast Cancer. Clin Breast Cancer 2012; 12:102-9. [DOI: 10.1016/j.clbc.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/30/2011] [Accepted: 10/14/2011] [Indexed: 10/14/2022]
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Surgical treatment of early stage breast cancer in elderly: an international comparison. Breast Cancer Res Treat 2011; 132:675-82. [PMID: 22119939 PMCID: PMC3303082 DOI: 10.1007/s10549-011-1892-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 10/28/2022]
Abstract
Over 40% of breast cancer patients are diagnosed above the age of 65. Treatment of these elderly patients will probably vary over countries. The aim of this study was to make an international comparison (several European countries and the US) of surgical and radiation treatment for elderly women with early stage breast cancer. Survival comparisons were also made. Data were obtained from national or regional population-based registries in the Netherlands, Switzerland, Ireland, Belgium, Germany, and Portugal. For the US patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Early stage breast cancer patients aged ≥ 65 diagnosed between 1995 and 2005 were included. An international comparison was made for breast and axillary surgery, radiotherapy after breast conserving surgery (BCS), and relative or cause-specific survival. Overall, 204.885 patients were included. The proportion of patients not receiving any surgery increased with age in many countries; however, differences between countries were large. In most countries more than half of all elderly patients received breast conserving surgery (BCS), with the highest percentage in Switzerland. The proportion of elderly patients that received radiotherapy after BCS decreased with age in all countries. Moreover, in all countries the proportion of patients who do not receive axillary surgery increased with age. No large differences in survival between countries were recorded. International comparisons of surgical treatment for elderly women with early stage breast cancer are scarce. This study showed large international differences in treatment of elderly early stage breast cancer patients, with the most striking result the large proportion of elderly who did not undergo surgery at all. Despite large treatment differences, survival does not seem to be affected in a major way.
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