Mark Fairweather1,2, Wei Jiang3, Nancy L Keating4,5, Rachel A Freedman2, Tari A King1,2, Faina Nakhlis6,7. 1. Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 2. Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. 3. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 4. Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 6. Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. fnakhlis1@bwh.harvard.edu. 7. Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. fnakhlis1@bwh.harvard.edu.
Abstract
PURPOSE: Limited data exist to guide the management of in-breast tumors that can produce physical and emotional discomfort in the setting of metastatic disease. We evaluated the morbidity of local therapy (LT) among patients with locally advanced metastatic breast cancer. METHODS: Patients with de novo T4M1 breast cancer diagnosed between 2005 and 2011 were identified from the SEER-Medicare database. We assessed receipt of care for loco-regional morbidity before and after LT. RESULTS: Among 3660 patients with T4M1 disease, 1558 (43%) underwent LT [surgery (19%), radiation (15%), both (9%)]. Before LT, few patients were reported to have loco-regional morbidity (7.9% vs. 6.7% for no LT, P = 0.17). Following LT, patients were reported to have more loco-regional morbidity than patients who did not have LT (22.6% vs. 7.9%). More patients without baseline loco-regional morbidity were reported to have received care for loco-regional morbidity documented after LT compared to baseline loco-regional morbidity reported in patients without LT (19.9% vs. 6.3%, P < 0.001). CONCLUSIONS: The need to address loco-regional morbidity is relatively infrequent among patients with T4M1 disease who do not undergo LT. Receipt of care for loco-regional morbidity was higher following LT. For patients without existing loco-regional morbidity, risks of LT may outweigh potential benefits.
PURPOSE: Limited data exist to guide the management of in-breast tumors that can produce physical and emotional discomfort in the setting of metastatic disease. We evaluated the morbidity of local therapy (LT) among patients with locally advanced metastatic breast cancer. METHODS:Patients with de novo T4M1 breast cancer diagnosed between 2005 and 2011 were identified from the SEER-Medicare database. We assessed receipt of care for loco-regional morbidity before and after LT. RESULTS: Among 3660 patients with T4M1 disease, 1558 (43%) underwent LT [surgery (19%), radiation (15%), both (9%)]. Before LT, few patients were reported to have loco-regional morbidity (7.9% vs. 6.7% for no LT, P = 0.17). Following LT, patients were reported to have more loco-regional morbidity than patients who did not have LT (22.6% vs. 7.9%). More patients without baseline loco-regional morbidity were reported to have received care for loco-regional morbidity documented after LT compared to baseline loco-regional morbidity reported in patients without LT (19.9% vs. 6.3%, P < 0.001). CONCLUSIONS: The need to address loco-regional morbidity is relatively infrequent among patients with T4M1 disease who do not undergo LT. Receipt of care for loco-regional morbidity was higher following LT. For patients without existing loco-regional morbidity, risks of LT may outweigh potential benefits.
Entities:
Keywords:
Local therapy; Metastatic breast cancer; Morbidity; Radiation; Surgery