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Heinig M, Heinze F, Schwarz S, Haug U. Initial and ten-year treatment patterns among 11,000 breast cancer patients undergoing breast surgery-an analysis of German claims data. BMC Cancer 2022; 22:130. [PMID: 35109813 PMCID: PMC8812022 DOI: 10.1186/s12885-022-09240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to explore the potential of German claims data for describing initial and long-term treatment patterns of breast cancer patients undergoing surgery. METHODS Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we included patients with invasive breast cancer diagnosed in 2008 undergoing breast surgery and followed them until 2017. We described initial and long-term treatment patterns and deaths. Analyses were stratified by stage (as far as available in claims data), age at diagnosis, and mode of detection (screen-detected vs. interval vs. unscreened cases). RESULTS The cohort comprised 10,802 patients. The proportion with neoadjuvant therapy was highest in patients < 50 years (19% vs. ≤ 8% at older ages). The proportion initiating adjuvant chemotherapy within four months after diagnosis decreased with age (< 50 years: 63%, 50-69: 46%, 70-79: 27%, 80 + : 4%). Among women < 69 years, ~ 30% had two breast surgeries in year one (70-79: 21%, 80 + : 14%). Treatment intensity was lower for screen-detected compared to interval or unscreened cases, both in year one (e.g., proportion with mastectomy ~ 50% lower) and within 2-10 years after surgery (proportions with radiotherapy or chemotherapy about one third lower each). CONCLUSIONS This study illustrates the potential of routine data to describe breast cancer treatment and provided important insights into differences in initial and long-term treatment by mode of detection and age.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center On Inequality and Social Policy, University of Bremen, 28359, Bremen, Germany
| | - Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Grazer Str. 2, 28359, Bremen, Germany
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Oliveira JCDS, Galvão ND, Páscoa MARD, Azevedo EFSD, Silva AMCD. Breast cancer survival in Great Cuiaba, Brazil: a population-based study. ACTA ACUST UNITED AC 2021; 42:e20190509. [PMID: 33566945 DOI: 10.1590/1983-1447.2021.20190509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze ten-year specific survival of women with breast cancer in Great Cuiaba, Mato Grosso, Brazil. METHODS A population-based cohort of 61 women diagnosed with breast cancer in 2008 and 2009, in Great Cuiabá, Mato Grosso, followed by 2018 in the regional mortality database. Specific survival was analyzed through the Kaplan-Meier curve, with adjustment of the Weibull model and Log-Weibull Regression. The survival curves of the variables were compared using the log-rank test which were statistically significance (p<0.05). RESULTS The mean time to death is approximately 51.1 months. Women aged ≤ 50 years and of white race/color presented the worst survival. CONCLUSION We found out that age, race/color affect specific survival and there is a need for reviewing the control plan for breast cancer in order to increase the survival of women diagnosed with this pathology.
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Affiliation(s)
- Jânia Cristiane de Souza Oliveira
- Universidade Federal de Rondonópolis (UFR), Instituto de Ciências Exatas e Naturais, Curso de Graduação em Enfermagem. Rondonópolis, Mato Grosso, Brasil
| | - Noemi Dreyer Galvão
- Universidade Federal de Mato Grosso (UFMT), Instituto de Saúde Coletiva, Departamento de Saúde Coletiva. Cuiabá, Mato Grosso, Brasil
| | - Marcelino Alves Rosa de Páscoa
- Universidade Federal de Mato Grosso (UFMT), Instituto de Ciências Exatas e da Terra, Departamento de Estatística. Cuiabá, Mato Grosso, Brasil
| | | | - Ageo Mário Cândido da Silva
- Universidade Federal de Mato Grosso (UFMT), Instituto de Saúde Coletiva, Departamento de Saúde Coletiva. Cuiabá, Mato Grosso, Brasil
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DuMontier C, Loh KP, Bain PA, Silliman RA, Hshieh T, Abel GA, Djulbegovic B, Driver JA, Dale W. Defining Undertreatment and Overtreatment in Older Adults With Cancer: A Scoping Literature Review. J Clin Oncol 2020; 38:2558-2569. [PMID: 32250717 PMCID: PMC7392742 DOI: 10.1200/jco.19.02809] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The terms undertreatment and overtreatment are often used to describe inappropriate management of older adults with cancer. We conducted a comprehensive scoping review of the literature to clarify the meanings behind the use of the terms. METHODS We searched PubMed (National Center for Biotechnology Information), Embase (Elsevier), and CINAHL (EBSCO) for titles and abstracts that included the terms undertreatment or overtreatment with regard to older adults with cancer. We included all types of articles, cancer types, and treatments. Definitions of undertreatment and overtreatment were extracted, and categories underlying these definitions were derived through qualitative analysis. Within a random subset of articles, C.D. and K.P.L. independently performed this analysis to determine final categories and then independently assigned these categories to assess inter-rater reliability. RESULTS Articles using the terms undertreatment (n = 236), overtreatment (n = 71), or both (n = 51) met criteria for inclusion in our review (n = 256). Only 14 articles (5.5%) explicitly provided formal definitions; for the remaining, we inferred the implicit definitions from the terms' surrounding context. There was substantial agreement (κ = 0.81) between C.D. and K.P.L. in independently assigning categories of definitions within a random subset of 50 articles. Undertreatment most commonly implied less than recommended therapy (148; 62.7%) or less than recommended therapy associated with worse outcomes (88; 37.3%). Overtreatment most commonly implied intensive treatment of an older adult in whom the harms of treatment outweigh the benefits (38; 53.5%) or intensive treatment of a cancer not expected to affect an older adult in his/her remaining lifetime (33; 46.5%). CONCLUSION Undertreatment and overtreatment of older adults with cancer are imprecisely defined concepts. We propose new, more rigorous definitions that account for both oncologic factors and geriatric domains.
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Affiliation(s)
- Clark DuMontier
- Brigham and Women’s Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tammy Hshieh
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Jane A. Driver
- Brigham and Women’s Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Veterans Affairs Boston Healthcare System, New England Geriatric Research Education and Clinical Center, Boston, MA
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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What Are Young Women Living Conditions after Breast Cancer? Health-Related Quality of Life, Sexual and Fertility Issues, Professional Reinsertion. Cancers (Basel) 2020; 12:cancers12061564. [PMID: 32545701 PMCID: PMC7353050 DOI: 10.3390/cancers12061564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
In recent decades, the living conditions of young breast cancer (BC) survivors have garnered increasing attention. This population-based study aimed to identify the clinical, social and economic determinants of Health-Related Quality of Life (HRQoL), and to describe other living conditions of young long-term BC survivors. Women with non-metastatic BC diagnosed between 2006 and 2015, aged 45 years and younger at the time of diagnosis, were identified through the Breast and Gynecologic Cancer Registry of the Côte d’Or, France. Participants completed self-report questionnaires including standardized measures of HRQoL, anxiety, depression, social deprivation, social support and sexuality. Fertility and professional reintegration issues were also assessed. The determinants of HRQoL were identified using mixed regression model. In total, 218 BC survivors participated in the survey. The main determinants of poor HRQoL were anxiety, depression, comorbidities, social deprivation and menopausal status. Among 72% of women who did not receive information about fertility preservation, 38% of them would have liked to have been informed. Finally, 39% of survivors reported a negative impact of BC on their professional activity. This study showed that BC stage or treatments did not have an impact on HRQOL of young long-term BC survivors. Fertility, sexuality and professional reintegration remained the main concerns for survivors. Specific interventions in these population should focus on these issues.
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Baeyens-Fernández JA, Molina-Portillo E, Pollán M, Rodríguez-Barranco M, Del Moral R, Arribas-Mir L, Sánchez-Cantalejo Ramírez E, Sánchez MJ. Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study. BMC Cancer 2018; 18:781. [PMID: 30068302 PMCID: PMC6090958 DOI: 10.1186/s12885-018-4682-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants. METHODS Data were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage. RESULTS Overall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases × 100,000 women in 1985-1989 to 83.4 in 2008-2012, with an annual percentage change (APC) of 2.5% (95%CI, 2.1-2.9) for 1985-2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%CI, 2.4-4.8). For 2000-2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%CI, 1.9-5.8). Overall age-adjusted breast cancer mortality decreased (APC - 1, 95%CI, - 1.4 - - 0.5), as did mortality in the 50-69 year age group (APC - 1.3, 95%CI, - 2.2 - - 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985-1989 to 83.7% in 2010-2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 23.3% for stage IV. CONCLUSIONS Breast cancer incidence is increasing - a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50-69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70-84 year age group and for metastatic tumors.
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Affiliation(s)
- José Antonio Baeyens-Fernández
- Departamento de Urgencias y Emergencias, Área de Gestión Sanitaria Noreste, Hospital Regional de Baza, Carretera de Murcia s/n, 18800 Baza, Spain
| | - Elena Molina-Portillo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Marina Pollán
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Environmental and Cancer Epidemiology Department, National Center of Epidemiology - Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Rosario Del Moral
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Lorenzo Arribas-Mir
- Centro de Salud La Chana, Área de Gestión Sanitaria Granada-Metropolitano, Granada, Spain
- Department of Epidemiology and Public Health, University of Granada, Granada, Spain
| | - Emilio Sánchez-Cantalejo Ramírez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
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Jensen JD, Cold S, Nielsen MH, Jylling AMB, Søe KL, Larsen LB, Ewertz M. Trends in breast cancer in the elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:59-64. [PMID: 26781003 DOI: 10.3109/0284186x.2015.1115118] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Breast cancer is the most frequent malignancy among women worldwide and the second most common cause of cancer-related death in developed countries. The aim of the present analysis is to describe trends in incidence, mortality, prevalence, and relative survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. MATERIAL AND METHODS Cancer of the breast was defined as ICD-10 code C50. Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS The proportion of patients diagnosed with breast cancer over the age of 70 years increased with time to 29% of women and 44% of men in 2012. Incidence rates increased with time and peaked around 2010 in all age groups except for those aged 90 years or more. Mortality rates were clearly separated by age with increasing mortality rates by increasing age group for both women and men. Relative survival increased over time in all age groups, but patients aged 70 years or more had a poorer relative survival than those aged less than 70 years. In 2012, 58 521 persons (all ages) were alive in Denmark after a diagnosis of breast cancer. CONCLUSION Poorer survival of Danish breast cancer patients over the age of 70 years is likely to be due to inferior treatment and non-adherence to treatment guidelines. There is a need for clinical trials focusing on patients over the age of 70 years.
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Affiliation(s)
- Jeanette D Jensen
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Søren Cold
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Mette H Nielsen
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Anne Marie B Jylling
- b Department of Clinical Pathology , Odense University Hospital , Odense , Denmark
| | - Katrine L Søe
- c Department of Plastic Surgery , Odense University Hospital , Odense , Denmark
| | - Lisbet B Larsen
- d Department of Radiology , Odense University Hospital , Odense , Denmark
| | - Marianne Ewertz
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
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Dialla PO, Arveux P, Ouedraogo S, Pornet C, Bertaut A, Roignot P, Janoray P, Poillot ML, Quipourt V, Dabakuyo-Yonli TS. Age-related socio-economic and geographic disparities in breast cancer stage at diagnosis: a population-based study. Eur J Public Health 2015; 25:966-72. [PMID: 25829506 DOI: 10.1093/eurpub/ckv049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to determine the impact of socio-economic and geographic disparities on disease stage at diagnosis according to age in breast cancer (BC) patients. Secondary purpose was to describe survival METHODS All women with primary invasive BC, diagnosed from 1998 to 2009 in the department of Côte d'Or were retrospectively selected using data from the Côte d'Or BC registry. European transnational ecological deprivation index (French European Deprivation Index) was used to measure the socio-economic environment. Relationships between socio-geographic deprivation and disease stage at diagnosis according to age were assessed by a multilevel ordered logistic regression model. Relative survival rates (RSRs) were given at 5 years according to tumour and patients characteristics. RESULTS In total, 4364 women were included. In multivariable analysis, socio-economic deprivation was associated with disease stage at diagnosis. Women aged between 50 and 74 years and living in deprived areas were more often diagnosed with advanced tumour stages (stages II/III vs. I or stages IV vs. II/III) with odds ratio = 1.27 (1.01-1.60). RSRs were lowest in women living in the most deprived area compared with those living in most affluent area with RSR = 88.4% (85.9-90.4) and 92.6% (90.5-94.2), respectively. CONCLUSIONS Socio-economic factors affected tumour stage at diagnosis and survival. Living in a deprived area was linked to advanced-stage BC at diagnosis only in women aged 50-74 years. This is probably due to the socio-economic disparities in participation in organized BC screening programmes. Furthermore, living in deprived area was associated with a poor survival rate.
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Affiliation(s)
- Pegdwende O Dialla
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Patrick Arveux
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Samiratou Ouedraogo
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Carole Pornet
- 3 Department of Epidemiological Research and Evaluation, CHU de Caen, France 4 EA3936, Medical School, Université de Caen Basse-Normandie, Caen, France 5 U1086 Inserm, Cancers and Preventions, Medical School, Université de Caen Basse-Normandie, Avenue de la Côte de Nacre, Caen, France
| | - Aurélie Bertaut
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | | | | | - Marie-Laure Poillot
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Valérie Quipourt
- 8 Coordination Unit in Geriatric oncology in Burgundy, Hôpital de jour Gériatrique, Hôpital de Champmaillot, Dijon, France
| | - Tienhan S Dabakuyo-Yonli
- 2 EA 4184, Medical School University of Burgundy, Dijon, France 9 Biostatistics and Quality of Life Unit, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France
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