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Daly GR, Dowling GP, Hamza E, AlRawashdeh M, Hegarty A, Naz T, McGrath J, Naidoo S, Downey E, Butt A, Power C, Hill ADK. Does Sentinel Lymph Node Biopsy Influence Subsequent Management Decisions in Women With Breast Cancer ≥ 70 Years Old? Clin Breast Cancer 2024; 24:510-518.e4. [PMID: 38821743 DOI: 10.1016/j.clbc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND There have been ongoing attempts to de-escalate surgical intervention in older breast cancer patients in recent years. However, there remains ongoing hesitancy amongst surgeons to de-implement axillary staging in this cohort. The supporting argument for performing a sentinel lymph node biopsy (SLNB) is that it may guide subsequent management. METHODS A retrospective review was performed of 356 SLNBs, in 342 women ≥ 70 years of age with invasive breast cancer, between 2014 and 2022 in a single institution. Data were collected on patient and tumor characteristics and subsequent management for all patients and for patients with ER+/HER2-, early-stage disease. RESULTS Positive SLNB significantly increased likelihood of receiving adjuvant chemotherapy (CTh) in patients aged 70-75 in all clinical subtypes (OR 4.0, 95% CI, 1.6-10; P = .0035). Positive SLNB did not significantly increase likelihood of receiving adjuvant CTh in patients aged 75-80, however, an Oncotype Dx score of ≥ 26 did (OR 34.50, 95% CI, 3.00-455.2; P = .0103). Positive SLNB was significantly associated with receiving adjuvant radiotherapy (RTh) in all patients aged 70-75 (OR 4.5, 95% CI, 2.0-11; P = .0004) and 75-80 (OR 9.7, 95% CI, 2.7-46; P = .0015). In patients aged ≥ 80 years, positive SLNB did not have a significant influence on subsequent treatments. CONCLUSION In this study, SLNB did not significantly influence subsequent management decisions in patients over 80 and should rarely be performed in this cohort. However, SLNB still had a role in patients aged 70-80 and should be used selectively in this cohort.
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Affiliation(s)
- Gordon R Daly
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Gavin P Dowling
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Eman Hamza
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Ma'en AlRawashdeh
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Hegarty
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Tarnum Naz
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Jason McGrath
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sindhuja Naidoo
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Downey
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Abeeda Butt
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Surgery, Beaumont Hospital, Dublin, Ireland
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Houvenaeghel G, Cohen M, Gonçalves A, Berthelot A, Chauvet MP, Faure C, Classe JM, Jouve E, Sabiani L, Bannier M, Tassy L, Martino M, Tallet A, de Nonneville A. Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment. Front Oncol 2023; 13:1287253. [PMID: 38162480 PMCID: PMC10757327 DOI: 10.3389/fonc.2023.1287253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups. Methods The medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years. Results Of 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031). Conclusion TN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Axel Berthelot
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | | | | | - Jean Marc Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - Eva Jouve
- Surgical Oncology Department, Centre Claudius Regaud, Toulouse, France
| | - Laura Sabiani
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marie Bannier
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Louis Tassy
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marc Martino
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Agnès Tallet
- Department of Radiotherapy, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Alexandre de Nonneville
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
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3
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White MJ, Kolbow M, Prathibha S, Praska C, Ankeny JS, LaRocca CJ, Jensen EH, Tuttle TM, Hui JYC, Marmor S. Chemotherapy refusal and subsequent survival in healthy older women with high genomic risk estrogen receptor-positive breast cancer. Breast Cancer Res Treat 2023; 198:309-319. [PMID: 36692668 DOI: 10.1007/s10549-023-06862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC. METHODS Retrospective review of the National Cancer Database (2010-2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane-Armitage test, multivariable logistical regression modeling, the Kaplan-Meier method, and Cox's proportional hazards modeling. RESULTS 6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014-2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65-74 (92% vs 95%) and 75-79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04-1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80-1.51). CONCLUSIONS Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65-79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.
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Affiliation(s)
- McKenzie J White
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Madison Kolbow
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Saranya Prathibha
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Corinne Praska
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA
- School of Medicine and Public Health, Department of Surgery, Clinical Science Center, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Jacob S Ankeny
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Christopher J LaRocca
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Eric H Jensen
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Jane Y C Hui
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
- Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN, 55455, USA.
- Center for Clinical Quality & Outcomes Discovery & Evaluation (C-QODE), University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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4
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Sreeram K, Seaton R, Greenwald MK, Kamgar M, Assad H, Baird T, Schwartz AG, Ruterbusch J, Simon MS. Chemotherapy-induced peripheral neuropathy in the detroit research on cancer survivors (ROCS) cohort. Cancer Causes Control 2023; 34:459-468. [PMID: 36934365 PMCID: PMC10373434 DOI: 10.1007/s10552-023-01676-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/08/2023] [Indexed: 03/20/2023]
Abstract
PURPOSE Improved life expectancy has increased the likelihood for long-term complications from chemotherapy among cancer survivors. One burdensome complication is chemotherapy-induced peripheral neuropathy (CIPN). We evaluated rates of CIPN outcomes in the Detroit Research on Cancer Survivorship (ROCS) cohort. METHODS The population included 1,034 African American (AA) survivors who received chemotherapy for breast, colorectal, lung or prostate cancer. CIPN prevalence was based on initial occurrence of worsening of self-reported pain, numbness or tingling after chemotherapy. Current CIPN included symptoms still present at the time of the survey, and persistent CIPN symptoms were present 12 or more months post-chemotherapy. CIPN severity was ranked as mild, moderate or severe. Logistic regression was utilized to evaluate sociodemographic and clinical factors associated with the various categories of CIPN. RESULTS CIPN prevalence was 68%, with 53% current and 52% persistent. The symptom severity distribution based on prevalent CIPN included 32.2% mild, 30.8% moderate, and 36.9% severe. Factors associated with prevalent CIPN (odds ratio, 95% confidence interval) included primary cancer site (breast: 3.88, 2.02-7.46); and (colorectal: 5.37, 2.69-10.73), lower risk for older age at diagnosis (0.66, 0.53-0.83) and divorced/separated marital status (2.13, 1.42-3.21). Current CIPN was in addition, associated with more advanced stage disease trend (1.34, 1.08-1.66) and greater number of co-morbid medical conditions trend (1.23, 1.09-1.40), as was persistent CIPN. Severity of prevalent CIPN was associated with history of arthritis (1.55, 1.06-2.26) and severity of persistent CIPN with higher BMI (1.58, 1.07-2.35). CONCLUSIONS CIPN is a common and persistent complication in AA cancer survivors. Further research is needed to improve our understanding of CIPN predictors in all groups of cancer survivors.
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Affiliation(s)
- Kalyan Sreeram
- Ascension St. Vincent Hospital, Indianapolis, IN, 46260, USA
| | - Randell Seaton
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA
| | - Mark K Greenwald
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Mandana Kamgar
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Hadeel Assad
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA.,Department of Oncology, Karmanos Cancer Institute at Wayne State University, 4100 John R, Detroit, MI, 48201, USA
| | - Tara Baird
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA.,Department of Oncology, Karmanos Cancer Institute at Wayne State University, 4100 John R, Detroit, MI, 48201, USA
| | - Ann G Schwartz
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA.,Department of Oncology, Karmanos Cancer Institute at Wayne State University, 4100 John R, Detroit, MI, 48201, USA
| | - Julie Ruterbusch
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA.,Department of Oncology, Karmanos Cancer Institute at Wayne State University, 4100 John R, Detroit, MI, 48201, USA
| | - Michael S Simon
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI, 48201, USA. .,Department of Oncology, Karmanos Cancer Institute at Wayne State University, 4100 John R, Detroit, MI, 48201, USA.
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5
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Hoffmann AS, Hennigs A, Feisst M, Moderow M, Heublein S, Deutsch TM, Togawa R, Schäfgen B, Wallwiener M, Golatta M, Heil J, Riedel F. Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017. Arch Gynecol Obstet 2023; 308:219-229. [PMID: 36604331 DOI: 10.1007/s00404-022-06902-9] [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: 11/20/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Today, the decision to treat patients with chemotherapy for early breast cancer (EBC) is made based on the patient's individual risk stratification and tumor biology. In cases with chemotherapy indication, the neoadjuvant application (NACT) is the preferred option in comparison with primary surgery and adjuvant chemotherapy (ACT). Age remains a relevant factor in the decision-making process. The aim of the present study was to illustrate the impact of age on the use of systemic therapy in clinical routine. METHODS The study separately analyzed chemotherapy use among six age cohorts of EBC patients who had been treated at 104 German breast units between January 2008 and December 2017. RESULTS In total, 124,084 patients were included, 46,279 (37.3%) of whom had received chemotherapy. For 44,765 of these cases, detailed information on treatment was available. Within this cohort, chemotherapy was administered as NACT to 14,783 patients (33.0%) and as ACT to 29,982 (67.0%) patients. Due to the higher prevalence of unfavorable tumor subtypes, younger patients had a higher rate of chemotherapy (≤ 29y: 74.2%; 30-39y: 71.3%) and a higher proportion of NACT administration ( ≤ 29y: 66.9%; 30-39y: 56.0%) in comparison with elderly patients, who had lower rates for overall chemotherapy (60-69y: 37.5%; ≥ 70y: 17.6%) and NACT (60-69y: 25.5%; ≥ 70y: 22.8%). Pathologic complete response was higher in younger than in older patients (≤ 29y: 30.4% vs. ≥ 70y: 16.7%), especially for HER2- subtypes. CONCLUSION The data from the nationwide German cohort reveal relevant age-dependent discrepancies concerning the use of chemotherapy for EBC.
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Affiliation(s)
- Ann Sophie Hoffmann
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - Thomas Maximilian Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- Heidelberg Breast Center at the St. Elisabeth Clinic, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- Heidelberg Breast Center at the St. Elisabeth Clinic, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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The impact of age and nodal status on variations in oncotype DX testing and adjuvant treatment. NPJ Breast Cancer 2022; 8:27. [PMID: 35232996 PMCID: PMC8888624 DOI: 10.1038/s41523-022-00394-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/24/2022] [Indexed: 12/26/2022] Open
Abstract
Oncotype DX (ODX) recurrence score (RS) is a validated tool to guide the use of adjuvant chemotherapy (AC) in hormone receptor+/HER2- breast cancer. In this analysis, we examine (1) characteristics associated with ODX testing and (2) the association between ODX RS and receipt of AC across age and nodal status. Women with HR+/HER2–, early-stage (T1-2, N0-1) breast cancers from 2010–2017 in the National Cancer Database were included. 530,125 met inclusion and 255,971 received ODX testing. Older women were less likely to receive testing; however, nodal positivity increased use of testing. High ODX RS was associated with increased mortality, though the association was not consistent across age and was most strongly associated with mortality among younger, node-negative women. Older women with high ODX RS, regardless of nodal status, were less likely to receive AC. Clinicians may be employing ODX RS to support treatment decisions against the receipt of AC.
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7
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Clinicopathological characteristics in women with breast cancer in extreme ages in Greece: A single centre experience. FORUM OF CLINICAL ONCOLOGY 2022. [DOI: 10.2478/fco-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Breast cancer is the most common malignancy in Greek women. The highest incidence occurs in patients aged 40–70 years. However, the emergence of the disease in women under 40 and over 80 years old is a significant problem in everyday practice, because of the diagnostic and therapeutic challenges for these age groups. The objective of this study is to investigate clinicopathological characteristics of Greek women under 40 and over 80 diagnosed with breast cancer during 2019–2020 in a specialized Breast Cancer Surgical Centre, as well as the pathological characteristics of their disease and the therapeutic measures applied to these women.
Aim of the study
The aim of this study is to compare clinical and pathological characteristics of breast cancer in a group of Greek premenopausal women younger than 40 years of age with a group of elderly women older than 80 years old, who were treated in a surgical breast centre in Greece during the last two years.
Patients and Methods
During the last 2 years, 21 women under 40 and 22 women older than 80 were diagnosed with breast cancer in our Centre.
Results
Invasive ductal adenocarcinoma was the most frequent histological type for both Groups: Most younger women underwent surgery followed by chemotherapy, while the majority of older patients received hormonal therapy after surgery.
Conclusions
There were no statistically significant differences between women under 40 and women over 80 in the study sample regarding their clinicopathological characteristics. However, younger women underwent more therapeutic modalities (i.e.adjuvant treatments in addition to surgery) than older ones.
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Mohamed MR, Kyi K, Mohile SG, Xu H, Culakova E, Loh KP, Flannery M, Obrecht S, Ramsdale E, Patil A, Dunne RF, DiGiovanni G, Hezel A, Burnette B, Desai N, Giguere J, Magnuson A. Prevalence of and factors associated with treatment modification at first cycle in older adults with advanced cancer receiving palliative treatment. J Geriatr Oncol 2021; 12:1208-1213. [PMID: 34272204 DOI: 10.1016/j.jgo.2021.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Treatment toxicities are common in older adults with cancer and consequently, treatment modifications are sometimes considered. We evaluated the prevalence and factors associated with treatment modifications at the first cycle in older patients receiving palliative systemic treatment. METHODS Patients (n = 369) from the GAP 70+ Trial (NCT02054741; PI: Mohile) usual care arm were included. Enrolled patients were aged 70+ with advanced cancer and ≥ 1 Geriatric Assessment (GA) domain impairment. Treatment modification was defined as any change from National Comprehensive Cancer Network guidelines or published clinical trials. Baseline variables included: 1) sociodemographic factors; 2) clinical variables; 3) GA domains; and 4) physician beliefs about life expectancy. Bivariate analyses and multivariable cluster-weighted generalized estimating equation model were conducted to assess the association of baseline variables with cycle 1 treatment modifications. RESULTS Mean age was 77.2 years (range: 70-94); 62% had lung or gastrointestinal cancers, and 35% had treatment modifications at cycle 1. Increasing age by one year (odds ratio (OR) 1.1, 95% confidence interval [CI] 1.0-1.2), receipt of ≥second line of chemotherapy (OR 1.8, CI 1.1-3.0), functional impairment (OR 1.6, CI 1.1-2.3) and income ≤$50,000 (OR 1.7, CI 1.1-2.4) were independently associated with a higher likelihood of cycle 1 treatment modification. CONCLUSION Treatment modifications occurred in 35% of older adults with advanced cancer at cycle 1. Increasing age, receipt of ≥second line of chemotherapy, functional impairment, and lower income were independently associated with treatment modifications. These findings emphasize the need for evidence-based regimens in older adults with cancer and GA impairments.
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Affiliation(s)
- Mostafa R Mohamed
- James P Wilmot Cancer Institute, University of Rochester, New York, USA; Department of Public Health Sciences, University of Rochester, New York, USA
| | - Kaitlin Kyi
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester, New York, USA
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester, New York, USA
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Marie Flannery
- School of Nursing, University of Rochester, New York, USA
| | - Spencer Obrecht
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Erika Ramsdale
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Amita Patil
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Richard F Dunne
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Grace DiGiovanni
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Aram Hezel
- James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Brian Burnette
- Cancer Research of Wisconsin and Northern Michigan, NCORP, USA
| | | | | | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester, New York, USA.
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Tanguy-Melac A, Denis P, Fagot-Campagna A, Gastaldi-Ménager C, Laurent M, Tuppin P. Intensity of Care, Expenditure, and Place of Death in French Women in the Year Before Their Death From Breast Cancer: A Population-Based Study. Cancer Control 2020; 27:1073274820977175. [PMID: 33356850 PMCID: PMC8480356 DOI: 10.1177/1073274820977175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Health care utilization of women with breast cancer (BC) during the last year of life, together with the causes and place of death and associated expenditure have been poorly described. Women treated for BC (2014-2015) with BC as a cause of death in 2015 and covered by the national health insurance general scheme (77% of the population) were identified in the French health data system (n = 6,696, mean age: 68.7 years, SD ± 15). Almost 70% died in short-stay hospitals (SSH), 4% in hospital-at-home (HaH), 9% in Rehab, 5% in skilled nursing homes (SNH) and 12% at home. One-third presented cardiovascular comorbidity. During the last year, 90% were hospitalized at least once in SSH, 25% in Rehab, 13% in HaH and 71% received hospital palliative care (HPC), but only 5% prior to their end-of-life stay. During the last month, 85% of women were admitted at least once to a SSH, 42% via the emergency department, 10% to an ICU, 24% received inpatient chemotherapy and 18% received outpatient chemotherapy. Among the 83% of women who died in hospital, independent factors for HPC use were cardiovascular comorbidity (adjusted odds ratio, aOR: 0.83; 95%CI: 0.72-0.95) and, in the 30 days before death, at least one SNH stay (aOR: 0.52; 95%CI: 0.36-0.76), ICU stay (aOR: 0.36; 95%CI: 0.30-0.43), inpatient chemotherapy (aOR: 0.55; 95%CI: 0.48-0.63), outpatient chemotherapy (aOR: 0.60; 95%CI: 0.51-0.70), death in Rehab (aOR: 1.4; 95%CI: 1.05-1.86) or HAH (aOR: 4.5; 95%CI: 2.47-8.1) vs SSH. Overall mean expenditure reimbursed per woman was €38,734 and €42,209 for those with PC. Women with inpatient or outpatient chemotherapy during the last month had lower rates of HPC, suggesting declining use of HPC before death. This study also indicates SSH-centered management with increased use of HPC in HaH and Rehab units and decreased access to HPC in SNH.
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Affiliation(s)
| | - Pierre Denis
- 27054Caisse Nationale d'Assurance Maladie (CNAM), Paris, France
| | | | | | | | - Philippe Tuppin
- 27054Caisse Nationale d'Assurance Maladie (CNAM), Paris, France
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10
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Abstract
The number of older adults with cancer is growing in the United States, and there is a relative paucity of data relating the presence of frailty with its outcomes of interest. The authors present the surgical oncology, radiation oncology, and medical oncology literature with respect to the presence of frailty in older adults with cancer. More research is needed to understand how the presence of frailty should be used by surgical, radiation, and medical oncologists to guide patient counseling and treatment planning.
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Affiliation(s)
- Christina A Minami
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Breast Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1274, Boston, MA 02215, USA
| | - Zara Cooper
- Division of Trauma, Burn, and Critical Care, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Suite 2-016, Boston, MA 02120, USA.
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11
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Communication involving special populations: older adults with cancer. Curr Opin Support Palliat Care 2019; 13:64-68. [DOI: 10.1097/spc.0000000000000408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients? Ir J Med Sci 2018; 188:379-388. [DOI: 10.1007/s11845-018-1851-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022]
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13
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Moi SH, Lee YC, Chuang LY, Yuan SSF, Ou-Yang F, Hou MF, Yang CH, Chang HW. Cumulative receiver operating characteristics for analyzing interaction between tissue visfatin and clinicopathologic factors in breast cancer progression. Cancer Cell Int 2018; 18:19. [PMID: 29449787 PMCID: PMC5807850 DOI: 10.1186/s12935-018-0517-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/31/2018] [Indexed: 01/16/2023] Open
Abstract
Background Visfatin has been reported to be associated with breast cancer progression, but the interaction between the visfatin and clinicopathologic factors in breast cancer progression status requires further investigation. To address this problem, it is better to simultaneously consider multiple factors in sensitivity and specificity assays. Methods In this study, a dataset for 105 breast cancer patients (84 disease-free and 21 progressing) were chosen. Individual and cumulative receiver operating characteristics (ROC) were used to analyze the impact of each factor along with interaction effects. Results In individual ROC analysis, only 3 of 13 factors showed better performance for area under curve (AUC), i.e., AUC > 7 for hormone therapy (HT), tissue visfatin, and lymph node (LN) metastasis. Under our proposed scoring system, the cumulative ROC analysis provides higher AUC performance (0.746–0.886) than individual ROC analysis in predicting breast cancer progression. Considering the interaction between these factors, a minimum of six factors, including HT, tissue visfatin, LN metastasis, tumor stage, age, and tumor size, were identified as being highly interactive and associated with breast cancer progression, providing potential and optimal discriminators for predicting breast cancer progression. Conclusion Taken together, the cumulative ROC analysis provides better prediction for breast cancer progression than individual ROC analysis. Electronic supplementary material The online version of this article (10.1186/s12935-018-0517-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sin-Hua Moi
- 1Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan
| | - Yi-Chen Lee
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,3Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Yeh Chuang
- 4Department of Chemical Engineering & Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shyng-Shiou F Yuan
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu Ou-Yang
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,6Division of Breast Surgery and Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,7Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,8Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Hong Yang
- 1Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.,9Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Wei Chang
- Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,10Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.,11Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,12Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 2017; 67:362-377. [PMID: 28731537 DOI: 10.3322/caac.21406] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362-377. © 2017 American Cancer Society.
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Affiliation(s)
- Cecilia G Ethun
- General Surgery Resident, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mehmet A Bilen
- Assistant Professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Professor, Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Associate Professor, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Professor of Urology, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Viraj A Master
- Professor, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
- Director of Clinical Research, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
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15
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de Oliveira Mauro M, Matuo R, de David N, Strapasson RLB, Oliveira RJ, Stefanello MÉA, Kassuya CAL, de Cepa Matos MDF, Faria FJC, Costa DS. Actions of sesquiterpene lactones isolated from Moquiniastrum polymorphum subsp. floccosum in MCF7 cell line and their potentiating action on doxorubicin. BMC Pharmacol Toxicol 2017; 18:53. [PMID: 28662728 PMCID: PMC5492432 DOI: 10.1186/s40360-017-0156-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background In order to obtain better clinical results in anticancer therapies, polychemotherapy or combination therapies are used. For this, the combinations are required to increase the efficacy and reduce the adverse reactions of the associated chemotherapies. The aim of this study was to evaluate the cytotoxic, apoptotic and (anti)proliferative potential of two sesquiterpene lactones isolated from Moquiniastrum polymorphum, 11,13-diidrozaluzanin C (1) and gochnatiolide C (2), and their associations with chemotherapeutic agents irinotecan, tamoxifen, cisplatin, 5-fluouracyl and doxorubicin in the tumoral lineage of MCF-7 breast adenocarcinoma. Methods The analyses were performed by MTT cytotoxicity assays, drug combination index (CI), apoptosis morphological assay and cell proliferation assay. Treatments were evaluated with short exposure times (4 h), followed or not by recovery in drug-free medium for 24 h. For the cell viability assay the statistical analysis was performed using software INSTAT, and the ANOVA/Tukey test was applied. Combination Indices (CI) was made using CompuSyn software and demonstrated through isoboles. The assays that evaluated cell death and proliferation used statistical analysis SAS 9.4 (Statistical Analysis System), and the procedure adopted was PROC NPAR1WAY. The Wilcoxon test at 5% level was applied for comparing statistical differences. Results The results demonstrated that the compounds decrease cell viability and increase their action when associated with irinotecan, tamoxifen and doxorubicin (CI < 1 and CI = 1). In periods of 4 h-exposure, the compounds cause cell death by apoptosis and after 24 h, they increase the mean number of cells in programmed cell death, especially when treated with 2. In addition, the association with doxorubicin increases the apoptotic potential induced by tested compounds. Both isolates had effect on the reduction of the number of mitoses, especially when 2 at its highest concentration is associated with doxorubicin. Conclusions Finally, these compounds are presented as potential agents in chemotherapy combined with doxorubicin, since they trigger the mechanism of apoptosis, which, through the mechanism of action of sesquiterpene lactones, leads to a reduction in toxicity. In addition, the tested compounds have the ability to exert a synergistic action with doxorubicin, possibly by down-regulating the drug resistance mechanisms.
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Affiliation(s)
- Mariana de Oliveira Mauro
- Programa de Pós-Graduação em Biotecnologia e Biodiversidade, Doutorado Rede Pró Centro-Oeste, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, 79070-900, Brazil
| | - Renata Matuo
- Programa de Mestrado em Farmácia, Centro de Ciências Biológicas e da Saúde (CCBS), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Natan de David
- Programa de Mestrado em Farmácia, Centro de Ciências Biológicas e da Saúde (CCBS), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Rodrigo Juliano Oliveira
- Programa de Mestrado em Farmácia, Centro de Ciências Biológicas e da Saúde (CCBS), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil. .,Centro de Estudos em Células Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Hospital Universitário Maria Aparecida Pedrossian (HUMAP), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil.
| | | | | | - Maria de Fátima de Cepa Matos
- Programa de Mestrado em Farmácia, Centro de Ciências Biológicas e da Saúde (CCBS), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Fábio José Carvalho Faria
- Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Deiler Sampaio Costa
- Programa de Pós-Graduação em Biotecnologia e Biodiversidade, Doutorado Rede Pró Centro-Oeste, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, 79070-900, Brazil.,Faculdade de Medicina Veterinária e Zootecnia (FAMEZ), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
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16
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Anampa J, Sparano JA. Tailoring Adjuvant Therapy for Breast Cancer in the Elderly: Room for Improvement. Breast J 2017; 23:253-255. [DOI: 10.1111/tbj.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jesus Anampa
- Department of Oncology; Montefiore Medical Center; Albert Einstein College of Medicine; Albert Einstein Cancer Center; Bronx New York
| | - Joseph A. Sparano
- Department of Oncology; Montefiore Medical Center; Albert Einstein College of Medicine; Albert Einstein Cancer Center; Bronx New York
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