Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis

Water, W. van de; Bastiaannet, E.; Dekkers, Olaf M.; Craen, Anton J. M. de; Westendorp, Rudi G.J.; Voogd, Adri C.; Velde, Cornelis J.H. van de; Liefers, G.J.

doi:10.1002/bjs.8743

Cited by 72 publications

(38 citation statements)

References 25 publications

(31 reference statements)

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“…Hence, systematic positive and linear relationship of adherence and survival is not replicable with incomplete multivariate models. In this sense, the present study is consistent with other reports [40, 41]. …”

Section: Discussionsupporting

confidence: 94%

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

2015

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BackgroundIn German breast cancer care, the S1-guidelines of the 1990s were substituted by national S3-guidelines in 2003. The application of guidelines became mandatory for certified breast cancer centers. The aim of the study was to assess guideline adherence according to time intervals and its impact on survival.MethodsWomen with primary breast cancer treated in three rural hospitals of one German geographical district were included. A cohort study design encompassed women from 1996–97 (N = 389) and from 2003–04 (N = 488). Quality indicators were defined along inpatient therapy sequences for each time interval and distinguished as guideline-adherent and guideline-divergent medical decisions. Based on all of the quality indicators, a binary overall adherence index was defined and served as a group indicator in multivariate Cox-regression models. A corrected group analysis estimated adjusted 5-year survival curves.ResultsFrom a total of 877 patients, 743 (85 %) and 504 (58 %) were included to assess 104 developed quality indicators and the resuming binary overall adherence index. The latter significantly increased from 13–15 % (1996–97) up to 33–35 % (2003–04). Within each time interval, no significant survival differences of guideline-adherent and -divergent treated patients were detected. Across time intervals and within the group of guideline-adherent treated patients only, survival increased but did not significantly differ between time intervals. Across time intervals and within the group of guideline-divergent treated patients only, survival increased and significantly differed between time intervals.ConclusionsInfrastructural efforts contributed to the increase of process quality of the examined certified breast cancer center. Paradoxically, a systematic impact on 5-year survival has been observed for patients treated divergently from the guideline recommendations. This is an indicator for the appropriate application of guidelines. A maximization of guideline-based decisions instead of the ubiquitous demand of guideline adherence maximization is advocated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1765-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 94%

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

2015

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“…This shows that there is still no consensus on how to treat elderly breast cancer patients. Also, elderly patients are often not treated according to guidelines [8,9]. Comorbid conditions and frailty are, besides age and patient and physician's preference, important reasons to deviate from the guidelines [10,11].…”

Section: Introductionmentioning

confidence: 99%

Breast cancer surgery in elderly patients: postoperative complications and survival

Rocco

Rispoli²,

Pagano

et al. 2013

BMC Surg

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Aims and backgroundOld age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications.MethodsWe retrospectively considered all female patients aged 65 years and older with invasive and in situ breast cancer who were diagnosed and treated between 1997 and 2012 in the Department of General and Geriatric Surgery of the University of Naples "Federico II".Results and conclusion449 patients received surgery, of whom 18,2% (n = 82) developed one or more postoperative complications. The odds ratio of having postoperative complications show an increase with age, reaching statistical significance only for patients older than 85 [OR 5,75 (95% confidence interval 2,38-14,04); p < 0,001]. Number of concomitant diseases [OR 2,51 (95% CI 1,17 - 5,45); p = 0,01 for 3 or more concomitant diseases] and polypharmacy [OR 16,7 (95% CI 9,12 - 30,58); p < 0,0001) are associated to an increased risk of postoperative complications. Overall survival was worse in patients with postoperative complications [HR 2,06 (95% CI 1,52-2,70), p < 0,001]. This increased risk of mortality is probably due to geriatric parameters such as comorbidity or poor physical function, more than to higher complication rates.

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“…29 This leads to a large diversity of treatment strategies and poor adherence to guidelines among treating specialists. 30 Consequently, breast cancer-specific mortality increases with age, even amid competing causes of death in older patients. 18 Therefore, new treatment strategies for elderly breast cancer patients are urgently needed.…”

Section: Discussionmentioning

confidence: 99%

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

Glas

Fontein

Bastiaannet

et al. 2014

Cancer

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BACKGROUND: Physical activity has been related to improved breast cancer outcomes. Especially in the older breast cancer population, physical activity may be important because old age is associated with comorbidities and decreased physical function. The purpose of this study was to investigate the relation between physical activity and overall survival, breast cancer-specific survival, and recurrence in several age groups of postmenopausal breast cancer patients. METHODS: The Tamoxifen Exemestane Adjuvant Multinational Lifestyle study was a side study of the Tamoxifen Exemestane Adjuvant Multinational trial and prospectively investigated lifestyle habits of postmenopausal, hormone receptor-positive breast cancer patients. The relations between prediagnosis and postdiagnosis physical activity and overall survival, breast cancer-specific survival, and recurrence-free survival were assessed with Cox regression and competing risk regression models. RESULTS: Among 521 patients, high levels of physical activity before and after the diagnosis were associated with better overall survival (the multivariate hazard ratios were 0.50 [95% confidence interval 5 0.26-0.98] and 0.57 (95% confidence interval 5 0.26-1.40] for patients who were very active before and after the diagnosis, respectively, in comparison with inactive patients). This was most evident in patients who were 65 years old or older. Physical activity was not significantly associated with breast cancer-specific survival or the relapse-free period. CONCLUSIONS: Overall survival was better for patients who were active before and after the diagnosis. In contrast with previous studies, breast cancer survival and the risk of recurrence were not significantly associated with physical activity. These findings confirmed the need for more studies investigating the use of physical activity to supplement breast cancer treatment in older patients. Cancer 2014;120:2847-54.

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Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis

Abstract: Adherence to treatment guidelines was affected by age at diagnosis. However, adherence to the guidelines was not associated with overall survival in either age group.

Cited by 72 publications

References 25 publications

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

The adherence paradox: guideline deviations contribute to the increased 5-year survival of breast cancer patients

Breast cancer surgery in elderly patients: postoperative complications and survival

Physical activity and survival of postmenopausal, hormone receptor–positive breast cancer patients: Results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study

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