Patients With Invasive Breast Cancer Who Refuse Treatment: An Analysis of Associated Factors and Impact on Survival

Background Completion of surgical resection and adjuvant/neoadjuvant treatments (chemotherapy, radiation, and endocrine therapy) is necessary to achieve optimal outcomes in invasive breast cancer. The objective of this study was to determine the characteristics of patients refusing treatment and to analyze the impact of refusal on survival. Study Design A retrospective cohort study of invasive breast cancer cases diagnosed 2004-2016 was performed utilizing the National Cancer Database. Results Of 2 058 568 cases comprising the study cohort, .6% refused recommended surgery, 14.1% refused chemotherapy, 5.5% refused radiation, and 6.3% refused endocrine therapy. Patients refusing therapy were older and more likely uninsured; they did not live farther from the treating hospital. Racial disparities were also associated with refusal. Surgery refusal had the highest hazard ratio for mortality (2.7; 95% CI: 2.5-3.0, P < .001) compared to chemotherapy (1.3; 95% CI: 1.3-1.4, P < .001), radiation (1.8; 95% CI: 1.7-1.9, P < .001), and endocrine therapy (1.5; 95% CI: 1.4-1.6, P < .001) independent of race, insurance, receptor status, and stage. Conclusion This study demonstrates significant associations with refusal of breast cancer treatment and quantifies the impact on mortality, which may help to identify at-risk groups for whom interventions could prevent increases in mortality associated with declining treatment.

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Impact of axillary lymph node dissection (ALND) on survival in patients with ypN1 breast cancer that receive regional nodal irradiation (RNI): A national cancer database (NCDB) analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.572 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 572-572

Author(s):

Michael Kharouta ◽

Nicholas Damico ◽

Eleanor Elizabeth Harris ◽

Janice A. Lyons

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Lymph Node ◽

Invasive Breast Cancer ◽

Axillary Lymph ◽

National Cancer Database ◽

Regional Nodal Irradiation ◽

Cox Regression Analysis ◽

Propensity Matching ◽

The Impact

572 Background: The innovation of sentinel lymph node biopsy (SLNB) has allowed many patients with invasive breast cancer to forego ALND. However, the benefit of ALND is unclear in patients with pathologic N1 disease detected on SLNB following neoadjuvant chemotherapy, particularly in patients who receive adjuvant regional nodal irradiation. Methods: The National Cancer Database (NCDB) was queried for women ages 18-75 with cT1-3N1, and ypT0-T3N1M0 invasive breast cancer who underwent definitive surgical resection with axillary staging and also received adjuvant RNI. Patients treated from 2012 – 2015 were included to allow for appropriate coding of extent of axillary surgery. Overall survival (OS) was estimated using the Kaplan-Meier method and compared between patients who received SLNB alone and ALND with or without SLNB utilizing log rank testing. Propensity matching was performed to reduce the impact of potential confounders and balance sample bias. Cox proportional hazards regression was used to identify predictors of overall survival. Results: A total of 1411 women were identified who met inclusion criteria. The median age was 52 (23-75) years. 206 (15%) women had SLNB alone and 1205 (85%) had ALND with or without SLNB. Five year OS was 73% in patients who underwent ALND compared to 76% in those who had SLNB alone (p =0.39). Following propensity matching by age, race, Charlson Deyo Comorbid Condition score, pT stage, grade, ER status, and HER2 status, 5 year OS was 79% in patients who underwent SLNB alone vs. 69% in patients who had ALND performed (p = 0.33). On Cox regression analysis, none of the variables predicted for 5 year OS. Conclusions: ALND in addition to RNI did not improve survival in patients with cT1-3N1M0 and ypT0-3N1M0 breast cancer compared to SLNB and RNI. We await results of the Alliance 011202 randomized trial for prospective validation of ALND omission in a similar subset of patients. [Table: see text]

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The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment

npj Breast Cancer ◽

10.1038/s41523-021-00276-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Mads G. Jørgensen ◽

Navid M. Toyserkani ◽

Frederik G. Hansen ◽

Anette Bygum ◽

Jens A. Sørensen

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Treatment ◽

Breast Cancer Treatment ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Impact

AbstractThe impact of breast cancer-related lymphedema (BCRL) on long-term quality of life is unknown. The aim of this study was to investigate the impact of BCRL on health-related quality of life (HRQoL) up to 10 years after breast cancer treatment. This regional population-based study enrolled patients treated for breast cancer with axillary lymph node dissection between January 1st 2007 and December 31th 2017. Follow up and assessments of the included patients were conducted between January 2019 and May 2020. The study outcome was HRQoL, evaluated with the Lymphedema Functioning, Disability and Health Questionnaire, the Disabilities of the Arm, Shoulder and Hand Questionnaire and the Short Form (36) Health Survey Questionnaire. Multivariate linear logistic regression models adjusted for confounders provided mean score differences (MDs) with 95% confidence intervals in each HRQoL scale and item. This study enrolled 244 patients with BCRL and 823 patients without BCRL. Patients with BCRL had significantly poorer HRQoL than patients without BCRL in 16 out of 18 HRQoL subscales, for example, in physical function (MDs 27, 95%CI: 24; 30), mental health (MDs 24, 95%CI: 21; 27) and social role functioning (MDs 20, 95%CI: 17; 23). Age, BMI, BCRL severity, hand and dominant arm affection had only minor impact on HRQoL (MDs < 5), suggesting a high degree of inter-individual variation in coping with lymphedema. This study showed that BCRL is associated with long-term impairments in HRQoL, especially affecting the physical and psychosocial domains. Surprisingly, BCRL diagnosis rather than clinical severity drove the largest impairments in HRQoL.

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Understanding the impact of breast cancer adjuvant endocrine therapy on cognitive function: a work in progress

British Journal of Cancer ◽

10.1038/bjc.2016.89 ◽

2016 ◽

Vol 114 (9) ◽

pp. 953-955 ◽

Cited By ~ 2

Author(s):

Patricia A Ganz

Keyword(s):

Breast Cancer ◽

Cognitive Function ◽

Endocrine Therapy ◽

Adjuvant Endocrine Therapy ◽

Work In Progress ◽

The Impact

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Breast Cancer Treatment Patterns in Women Age 80 and Over: A Report from the National Cancer Database

Clinical Breast Cancer ◽

10.1016/j.clbc.2021.07.005 ◽

2021 ◽

Author(s):

Julia Frebault ◽

Carmen Bergom ◽

Chandler S. Cortina ◽

Monica E. Shukla ◽

Yiwen Zhang ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Treatment ◽

Breast Cancer Treatment ◽

Treatment Patterns ◽

National Cancer Database ◽

80 And Over

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The impact of adjuvant endocrine therapy in early breast cancer on quality-of-life: an overview of prospective trials

Expert Review of Quality of Life in Cancer Care ◽

10.1080/23809000.2016.1157002 ◽

2016 ◽

Vol 1 (2) ◽

pp. 111-120 ◽

Cited By ~ 1

Author(s):

Eleonora Mioranza ◽

Cristina Falci ◽

Maria Vittoria Dieci ◽

Valentina Guarneri ◽

Pierfranco Conte

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Endocrine Therapy ◽

Early Breast Cancer ◽

Adjuvant Endocrine Therapy ◽

Prospective Trials ◽

The Impact

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Prognostic value of Bcl-2 in invasive breast cancer receiving chemotherapy and endocrine therapy

Oncology Reports ◽

10.3892/or.10.1.121 ◽

2003 ◽

Author(s):

Qifeng Yang ◽

Takeo Sakurai ◽

Goro Yoshimura ◽

Takaomi Suzuma ◽

Teiji Umemura ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Invasive Breast Cancer ◽

Prognostic Value

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Improving Access and Adherence to Endocrine Therapy With Nurse-Based Intervention

Journal of Global Oncology ◽

10.1200/jgo.18.10170 ◽

2018 ◽

Vol 4 (Supplement 3) ◽

pp. 15s-15s

Author(s):

Sefonias Getachew ◽

Adamu Addisse ◽

Lesley Taylor ◽

Eva J. Kantelhardt

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Hormone Receptor ◽

Nursing Intervention ◽

Tamoxifen Therapy ◽

Rural Ethiopia ◽

Long Term Treatment ◽

Nurse Navigator ◽

The Impact

Purpose The majority of women with breast cancer from low-income countries, including Ethiopia, present with advanced clinical stage disease, which results in limited and difficult therapeutic options and high mortality rates. In Ethiopia, breast cancer is the most common cancer. We found that 70% of breast cancer cases in Ethiopia are hormone receptor positive. Endocrine therapy is one of the treatment options recommended for breast cancer but that is highly underutilized in the country. Recommendations on interventions to improve uptake and adherence to therapy exist, but studies that have assessed the feasibility of implementing these are limited. Our study (n = 107) in rural Ethiopia revealed an estimated 53% 2-year survival rate in patients who underwent surgery only. In our pilot study, of 51 eligible patients 26 initiated therapy and one half of those adhered after 1 year. Our study aims to evaluate the effectiveness of using a trained breast nurse navigator to improve patient adherence to tamoxifen therapy among patients with breast cancer in rural Ethiopia. Methods A cluster randomized intervention trial is being carried out in rural hospitals in southwestern Ethiopia from February 2018 to June 2019. We use hospitals in clusters as the units of randomization. The sample size includes four per intervention arm and control arm, with each cluster comprised of approximately 15 patients. Before intervention, all patients in the hospitals will receive tamoxifen therapy free of charge. Hormone receptor status of the breast cancer specimen will be determined before the initiation of therapy or throughout the course of therapy. The primary outcome of this trial is adherence to endocrine therapy on the basis of objective and subjective measures. Data will be collected with a prospective repeated measures approach. Analysis will be based on an intention-to-treat principle. Results The trial aims to provide evidence on the effectiveness of the breast nurse intervention to improve adherence to long-term endocrine therapy and answer the following research question: does the nursing intervention improve long-term treatment adherence by patients to endocrine therapy compared with those who receive usual care services? Conclusion These data are essential to maximize the impact of trained nurse-based interventions on adherence to endocrine (tamoxifen) therapy among patients with breast cancer on follow-up. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Eva J. Kantelhardt Travel, Accommodations, Expenses: Daiichi Sankyo Oncology Europe

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