F A Angarita1, T Chesney2, C Elser3, A M Mulligan4, D R McCready5, J Escallon6. 1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada. Electronic address: fernando.angarita@mail.utoronto.ca. 2. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada. Electronic address: tyler.chesney@gmail.com. 3. Department of Medical Oncology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada. Electronic address: Christine.Elser@uhn.ca. 4. Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada. Electronic address: AnnaMarie.Mulligan@uhn.ca. 5. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5T 2M9, Canada. Electronic address: David.McCready@uhn.ca. 6. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON M5N 3M5, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5T 2M9, Canada; Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada. Electronic address: JEscallon@mtsinai.on.ca.
Abstract
BACKGROUND: Treatment of breast cancer in elderly women is limited by declining functional status and life expectancy. The impact of providing less aggressive treatment remains controversial. This study assessed the treatment patterns of elderly breast cancer patients. METHODS: Retrospective chart review of women ≥70 y with breast cancer treated between 2004 and 2011 at two large Canadian cancer centres. Tumour and treatment characteristics were collected across three subgroups: 70-74 y (n = 314), 75-79 y (n = 233), and ≥80 y (n = 219). Comparisons were made using Chi-squared test, Fisher-Freeman-Halton exact test, or ANOVA. Disease free (DFS) and overall (OS) survival were estimated by Kaplan-Meier analysis and compared by log-rank test. RESULTS: Women ≥80 y had larger tumours that were better differentiated, hormone receptor-positive, HER2-negative, and lymph node (LN)-positive relative to younger women (p < 0.05). Women ≥80 y more frequently underwent mastectomy than breast conserving surgery and lacked LN staging (p < 0.05). Chemotherapy was provided in few patients, especially ≥80 y. Radiation therapy was provided less often in women ≥80 y despite indications. Hormone therapy was more frequently provided in women ≥80 y. Women ≥80 y had a significantly lower DFS (17.5 m) relative to women 70-74 y (31 m, p = 0.02) and 75-79 y (35 m, p = 0.006). Women ≥80 y had the lowest median OS (53 m) relative to 70-74 y (79 m, p = 0.001) and 75-79 y (75 m, p = 0.003) women. CONCLUSIONS: Women ≥80 y received less aggressive treatment than younger women and had less favourable DFS and OS. Until age-specific recommendations are available physicians must use clinical judgement and assess the tumour biology with the patient's comorbidties to make the best choice.
BACKGROUND: Treatment of breast cancer in elderly women is limited by declining functional status and life expectancy. The impact of providing less aggressive treatment remains controversial. This study assessed the treatment patterns of elderly breast cancerpatients. METHODS: Retrospective chart review of women ≥70 y with breast cancer treated between 2004 and 2011 at two large Canadian cancer centres. Tumour and treatment characteristics were collected across three subgroups: 70-74 y (n = 314), 75-79 y (n = 233), and ≥80 y (n = 219). Comparisons were made using Chi-squared test, Fisher-Freeman-Halton exact test, or ANOVA. Disease free (DFS) and overall (OS) survival were estimated by Kaplan-Meier analysis and compared by log-rank test. RESULTS:Women ≥80 y had larger tumours that were better differentiated, hormone receptor-positive, HER2-negative, and lymph node (LN)-positive relative to younger women (p < 0.05). Women ≥80 y more frequently underwent mastectomy than breast conserving surgery and lacked LN staging (p < 0.05). Chemotherapy was provided in few patients, especially ≥80 y. Radiation therapy was provided less often in women ≥80 y despite indications. Hormone therapy was more frequently provided in women ≥80 y. Women ≥80 y had a significantly lower DFS (17.5 m) relative to women 70-74 y (31 m, p = 0.02) and 75-79 y (35 m, p = 0.006). Women ≥80 y had the lowest median OS (53 m) relative to 70-74 y (79 m, p = 0.001) and 75-79 y (75 m, p = 0.003) women. CONCLUSIONS:Women ≥80 y received less aggressive treatment than younger women and had less favourable DFS and OS. Until age-specific recommendations are available physicians must use clinical judgement and assess the tumour biology with the patient's comorbidties to make the best choice.
Authors: Elizabeth S Morrow; Ross D Dolan; Julie Doughty; Sheila Stallard; Alison Lannigan; Laszlo Romics Journal: Breast Cancer (Dove Med Press) Date: 2019-05-08