Mei Wei1,2, Xuechen Wang3, Danielle N Zimmerman4, Lindsay M Burt2,5, Benjamin Haaland2,3, N Lynn Henry6,7,8,9. 1. Division of Oncology, Department of Internal Medicine, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. 2. Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. 3. Population Health Science, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA. 4. Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, 85 North Medical Drive, Salt Lake City, UT, 84132, USA. 5. Department of Radiation Oncology, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. 6. Division of Oncology, Department of Internal Medicine, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. norahh@med.umich.edu. 7. Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. norahh@med.umich.edu. 8. Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, 500 S. State Street, Ann Arbor, MI, 48109, USA. norahh@med.umich.edu. 9. Rogel Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA. norahh@med.umich.edu.
Abstract
PURPOSE: To examine patterns of radiotherapy (RT) and endocrine therapy (ET) use, associations between RT omission and ET adherence, and associations among ET and RT use and disease recurrence in older women with early-stage, estrogen receptor-positive breast cancer. METHODS: Women age 65 and older diagnosed with hormone receptor-positive, clinically node-negative breast cancer between 2005 and 2018 and who did not undergo mastectomy were included. Multinomial logistic regression was used to examine the trends in practice patterns over time and by age. Kaplan-Meier estimates were used to estimate the probability of ET discontinuation. Cox proportional hazards models were constructed to assess associations between recurrence and ET/RT. RESULTS: Of the 484 enrolled patients, 47.9% patients underwent RT and initiated ET, 27.4% received ET alone, 10.2% received RT alone, and 13.8% patients received neither. Older patients had a higher probability of receiving ET alone or neither ET nor RT (both p < 0.001). The probability of initiating ET was greater among patients who underwent RT than those who omitted RT (p < 0.001). Regardless of RT status (RT or no RT), initiation and continuation of ET may be associated with reduced risk of recurrence. CONCLUSION: Patients who opt for no adjuvant therapy, or who do not tolerate ET, are at increased risk of disease recurrence if they omit RT. Clinicians should consider the likelihood a patient will adhere to ET prior to recommending omission of RT.
PURPOSE: To examine patterns of radiotherapy (RT) and endocrine therapy (ET) use, associations between RT omission and ET adherence, and associations among ET and RT use and disease recurrence in older women with early-stage, estrogen receptor-positive breast cancer. METHODS:Women age 65 and older diagnosed with hormone receptor-positive, clinically node-negative breast cancer between 2005 and 2018 and who did not undergo mastectomy were included. Multinomial logistic regression was used to examine the trends in practice patterns over time and by age. Kaplan-Meier estimates were used to estimate the probability of ET discontinuation. Cox proportional hazards models were constructed to assess associations between recurrence and ET/RT. RESULTS: Of the 484 enrolled patients, 47.9% patients underwent RT and initiated ET, 27.4% received ET alone, 10.2% received RT alone, and 13.8% patients received neither. Older patients had a higher probability of receiving ET alone or neither ET nor RT (both p < 0.001). The probability of initiating ET was greater among patients who underwent RT than those who omitted RT (p < 0.001). Regardless of RT status (RT or no RT), initiation and continuation of ET may be associated with reduced risk of recurrence. CONCLUSION:Patients who opt for no adjuvant therapy, or who do not tolerate ET, are at increased risk of disease recurrence if they omit RT. Clinicians should consider the likelihood a patient will adhere to ET prior to recommending omission of RT.
Entities:
Keywords:
Breast cancer; Early stage; Endocrine therapy; Older; Radiation therapy
Authors: Charles E Rutter; Nataniel H Lester-Coll; Brandon R Mancini; Christopher D Corso; Henry S Park; Debra N Yeboa; Cary P Gross; Suzanne B Evans Journal: Cancer Date: 2015-03-24 Impact factor: 6.860
Authors: Ian H Kunkler; Linda J Williams; Wilma J L Jack; David A Cameron; J Michael Dixon Journal: Lancet Oncol Date: 2015-01-28 Impact factor: 41.316
Authors: Alfred I Neugut; Milayna Subar; Elizabeth Ty Wilde; Scott Stratton; Corey H Brouse; Grace Clarke Hillyer; Victor R Grann; Dawn L Hershman Journal: J Clin Oncol Date: 2011-05-23 Impact factor: 44.544
Authors: William J Gradishar; Benjamin O Anderson; Jame Abraham; Rebecca Aft; Doreen Agnese; Kimberly H Allison; Sarah L Blair; Harold J Burstein; Chau Dang; Anthony D Elias; Sharon H Giordano; Matthew P Goetz; Lori J Goldstein; Steven J Isakoff; Jairam Krishnamurthy; Janice Lyons; P Kelly Marcom; Jennifer Matro; Ingrid A Mayer; Meena S Moran; Joanne Mortimer; Ruth M O'Regan; Sameer A Patel; Lori J Pierce; Hope S Rugo; Amy Sitapati; Karen Lisa Smith; Mary Lou Smith; Hatem Soliman; Erica M Stringer-Reasor; Melinda L Telli; John H Ward; Jessica S Young; Jennifer L Burns; Rashmi Kumar Journal: J Natl Compr Canc Netw Date: 2020-04 Impact factor: 11.908
Authors: Dawn L Hershman; Lawrence H Kushi; Theresa Shao; Donna Buono; Aaron Kershenbaum; Wei-Yann Tsai; Louis Fehrenbacher; Scarlett Lin Gomez; Sunita Miles; Alfred I Neugut Journal: J Clin Oncol Date: 2010-06-28 Impact factor: 44.544
Authors: Kevin S Hughes; Lauren A Schnaper; Jennifer R Bellon; Constance T Cirrincione; Donald A Berry; Beryl McCormick; Hyman B Muss; Barbara L Smith; Clifford A Hudis; Eric P Winer; William C Wood Journal: J Clin Oncol Date: 2013-05-20 Impact factor: 44.544
Authors: Alfred I Neugut; Xiaobo Zhong; Jason D Wright; Melissa Accordino; Jingyan Yang; Dawn L Hershman Journal: JAMA Oncol Date: 2016-10-01 Impact factor: 31.777