scholarly journals Assessing the Impact of a Cooperative Group Trial on Breast Cancer Care in the Medicare Population

2012 ◽  
Vol 30 (14) ◽  
pp. 1601-1607 ◽  
Author(s):  
Pamela R. Soulos ◽  
James B. Yu ◽  
Kenneth B. Roberts ◽  
Ann C. Raldow ◽  
Jeph Herrin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Life Expectancy ◽  
Older Women ◽  
Treatment Guidelines ◽  
Adjuvant Radiation ◽  
Adjusted Relative Risk ◽  
Data Set ◽  
Sample Mean ◽  
Medicare Population ◽  
The Impact

Purpose The Cancer and Leukemia Group B (CALGB) C9343 trial found that adjuvant radiation therapy (RT) provided minimal benefits for older women with breast cancer. Although treatment guidelines were changed to indicate that some women could forego RT, the impact of the C9343 results on clinical practice is unclear. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare data set to assess the use of adjuvant RT in a sample of women ≥ 70 years old diagnosed with stage I breast cancer from 2001 to 2007 who fulfilled the C9343 inclusion criteria. We used log-binomial regression to estimate the relation between publication of C9343 and use of RT in the full sample and across strata of patient and health system characteristics. Results Of the 12,925 Medicare beneficiaries in our sample (mean age, 77.7 years), 76.5% received RT. Approximately 79% of women received RT before study publication compared with 75% after (adjusted relative risk of receiving RT postpublication v prepublication: 0.97; 95% CI, 0.95 to 0.98). Although use of RT was lower after the trial within all strata of age and life expectancy, the magnitude of this decrease did not differ significantly by strata. For instance, among patients with life expectancy less than 5 years, RT use decreased by 3.7%, from 44.4% prepublication to 40.7% postpublication. Among patients with life expectancy ≥ 10 years, RT use decreased by 3.0%, from 92.0% to 89.0%. Conclusion The C9343 trial had minimal impact on the use of RT among older women in the Medicare population, even among the oldest women and those with shorter life expectancies.

scholarly journals Causes of Death and Relative Survival of Older Women After a Breast Cancer Diagnosis

2011 ◽  
Vol 29 (12) ◽  
pp. 1570-1577 ◽  
Author(s):  
Mara A. Schonberg ◽  
Edward R. Marcantonio ◽  
Long Ngo ◽  
Donglin Li ◽  
Rebecca A. Silliman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Stage I ◽  
Stage Ii ◽  
Mortality Data ◽  
Data Set ◽  
The Impact

Purpose To understand the impact of breast cancer on older women's survival, we compared survival of older women diagnosed with breast cancer with matched controls. Methods Using the linked 1992 to 2003 Surveillance, Epidemiology, and End Results (SEER) -Medicare data set, we identified women age 67 years or older who were newly diagnosed with ductal carcinoma in situ (DCIS) or breast cancer. We identified women not diagnosed with breast cancer from the 5% random sample of Medicare beneficiaries residing in SEER areas. We matched patient cases to controls by birth year and registry (99% or 66,039 patient cases matched successfully). We assigned the start of follow-up for controls as the patient cases' date of diagnosis. Mortality data were available through 2006. We compared survival of women with breast cancer by stage with survival of controls using multivariable proportional hazards models adjusting for age at diagnosis, comorbidity, prior mammography use, and sociodemographics. We repeated these analyses stratifying by age. Results Median follow-up time was 7.7 years. Differences between patient cases and controls in sociodemographics and comorbidities were small (< 4%). Women diagnosed with DCIS (adjusted hazard ratio [aHR], 0.7; 95% CI, 0.7 to 0.7) or stage I disease (aHR, 0.8; 95% CI, 0.8 to 0.8) had slightly lower mortality than controls. Women diagnosed with stage II disease or higher had greater mortality than controls (stage II disease: aHR, 1.2; 95% CI, 1.2 to 1.2). The association of a breast cancer diagnosis with mortality declined with age among women with advanced disease. Conclusion Compared with matched controls, a diagnosis of DCIS or stage I breast cancer in older women is associated with better survival, whereas a diagnosis of stage II or higher breast cancer is associated with worse survival.

The impact of cognitive impairment on survival and medication adherence among older women with breast cancer

Breast Cancer ◽  
2020 ◽  
Author(s):  
Yasser Alatawi ◽  
Richard A. Hansen ◽  
Chiahung Chou ◽  
Jingjing Qian ◽  
Vishnu Suppiramaniam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cognitive Impairment ◽  
Medication Adherence ◽  
Older Women ◽  
The Impact

scholarly journals A population-based study of the impact of the St-Gallen treatment guidelines on survival of women with node-negative breast cancer

The Breast ◽  
2003 ◽  
Vol 12 ◽  
pp. S17-S18
Author(s):  
N. Hebert-Croteau ◽  
J. Brisson ◽  
J. Latreille ◽  
M. Rivard ◽  
G. Martin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Guidelines ◽  
Population Based ◽  
Population Based Study ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
The Impact

How radiation oncologist accessibility influences treatment choice and quality in early-stage breast cancer: A SEER database analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6031-6031
Author(s):  
Thomas M. Churilla ◽  
Patrick E. Donnelly ◽  
Christopher A. Peters
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Partial Mastectomy ◽  
Adjuvant Radiation ◽  
Seer Database ◽  
Radiation Oncologist ◽  
Radiation Oncologists ◽  
The Impact

6031 Background: Mastectomy and breast conserving therapy (BCT, partial mastectomy and adjuvant radiotherapy) are equivalent in survival for treatment of early stage breast cancer. This study evaluated the impact of radiation oncologist accessibility on choice of mastectomy versus BCT, and the receipt of radiotherapy after BCT. Methods: In the NCI SEER database, breast cancer cases from 2004-2008 were selected with the following criteria: T2N1M0 or less, lobular or ductal histology, and treatment with simple mastectomy or partial mastectomy (+/-) adjuvant radiation. The HRSA Area Resource File was combined to define average radiation oncologist density (ROD, number of radiation oncologists/100K people) by county over the same time period. Tumor characteristics, demographic information, and ROD were evaluated with respect to mastectomy rates and receipt of radiation therapy after BCT in univariate and multivariate analyses. Results: In the 118,961 cases analyzed, mastectomy was performed 33.3% of the time relative to BCT. After adjustment for demographic and tumor variables, the odds of having mastectomy versus BCT were inversely associated with ROD (OR [95% CI] = 0.94 [0.93-0.96]; p<0.001). Adjuvant radiation therapy was not administered in 23.4% of BCT cases. Likewise, the odds of having BCT without adjuvant radiation were inversely associated with ROD (0.96 [0.95-0.98]; p<0.001, table). Conclusions: There was a significant, inverse and linear relationship between ROD and mastectomy rates independent of demographic and tumor variables. An inverse trend was also observed for the omission of radiotherapy after BCT. Access to radiation oncologists was a factor in surgical choice and receiving appropriate BCT in early stage breast cancer. [Table: see text]

Breast cancer in women aged 80 years and older: Clinical characteristics and treatment patterns according to biologic subtype.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12594-e12594
Author(s):  
Stephanie M Wong ◽  
Jean-Francois Boileau ◽  
Mariam Rana ◽  
Thierry Muanza ◽  
Richard G. Margolese ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Women ◽  
Clinical Characteristics ◽  
Triple Negative ◽  
Early Stage ◽  
Local Therapy ◽  
Adjuvant Radiation ◽  
Her2 Breast Cancer ◽  
Increased Risk ◽  
Biologic Subtype

e12594 Background: Older age is associated with poorer breast cancer-specific survival (BCSS) outcomes, despite a higher prevalence of biologically favorable disease. We sought to evaluate differences in the clinical characteristics and management of older women according to biologic subtype of breast cancer. Methods: The Surveillance, Epidemiology, and End Results (SEER) treatment database was queried to identify all women aged 80 years or older with a first diagnosis of invasive breast cancer between 2010 and 2016. Patients were subgrouped according to biologic subtype and clinical and treatment-related variables were compared. Multivariable logistic regression was then performed to determine factors independently associated with receipt of breast-conserving surgery (BCS) and adjuvant radiation. Results: Overall, 27,375 women with a median age of 84 (range, 80-108 years) met inclusion criteria. The majority of older women were diagnosed with HR+HER2- breast cancer (78.9%), followed by HER2+ (11.0%) and triple-negative breast cancer (TNBC) (10.0%). In women with stage I-III disease, non-operative management was employed in 13.4% of HR+HER2- patients, compared to 16.7% of HER2+ patients and 11.0% of TNBC (p < 0.001). In those undergoing surgery, BCS was most common in HR+HER2- patients (80.9%), compared to HER2+ (68.9%) and TNBC (67.8%; p < 0.001). Axillary surgery was performed in 74.0% of early stage patients with HR+HER2- disease, compared to patients with HER2+ (77.8%) and TNBC (79.3%; p < 0.001). In adjusted analyses controlling for stage and clinical variables, women aged 80 years or older with HER2+ breast cancer and TNBC had a lower likelihood of BCS (ORHER2+ 0.72, 95% CI 0.65-0.80; ORTNBC 0.72, 95% CI 0.65-0.81), and an increased likelihood of adjuvant radiation (ORHER2+ 1.14, 95% CI 1.02-1.27; ORTNBC 1.40, 95% CI 1.25-1.57). Conclusions: One fifth of women with breast cancer over age 80 are diagnosed with HER2+ and triple-negative subtypes, which are associated with more aggressive local therapy. Further studies are warranted to determine if higher rates of adjuvant radiation optimize local control in older HER2+ and TNBC patients at increased risk for early locoregional recurrences.

Breast Cancer Treatment Guidelines in Older Women

2005 ◽  
Vol 23 (4) ◽  
pp. 783-791 ◽  
Author(s):  
Sharon H. Giordano ◽  
Gabriel N. Hortobagyi ◽  
Shu-Wan C. Kau ◽  
Richard L. Theriault ◽  
Melissa L. Bondy
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Older Women ◽  
Surgical Therapy ◽  
Hormonal Therapy ◽  
Treatment Guidelines ◽  
Clinical Stage ◽  
Adjuvant Hormonal Therapy ◽  
Comorbidity Score

Purpose To determine patterns and predictors of concordance with institutional treatment guidelines among older women with breast cancer. Methods The study population included 1,568 patients aged 55 years and older who were treated at M.D. Anderson Cancer Center between July 1997 and January 2002 for stage I to IIIA invasive ductal and lobular breast cancer. Concordance with institutional guidelines was determined for definitive surgical therapy, radiotherapy after breast-conserving surgery, radiation therapy after mastectomy, adjuvant chemotherapy use, and adjuvant hormonal therapy use. The following variables were considered as possible modifiers of concordance: patient age, marital status, race, educational level, Eastern Cooperative Oncology Group performance status, comorbidity score, clinical stage, hormone receptor status, HER2-neu status, tumor grade, pathologic tumor size, lymphatic invasion, and number of lymph nodes involved. Logistic regression modeling was performed to determine the independent effect of each variable on guideline concordance. Results Older women were less likely to receive treatment in concordance with guidelines for definitive surgical therapy (P < .001), postlumpectomy radiation (P = .03), adjuvant chemotherapy (P < .001), and adjuvant hormonal therapy (P < .001). In multivariate analysis, age ≥ 75 years predicted a deviation from guidelines for definitive surgical therapy, adjuvant chemotherapy, and adjuvant hormonal therapy. Nonwhite race was associated with decreased likelihood of adjuvant radiation therapy after breast conservation. Conclusion After adjustment for comorbidity score, race, marital status, educational status, clinical stage, and tumor characteristics, increasing patient age was independently associated with decreased guideline concordance for definitive surgery, adjuvant chemotherapy, and adjuvant hormonal therapy. Future research should focus on delineating the possible reasons for guideline discordance.

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