Breast Cancer Adjuvant Chemotherapy Decisions in Older Women: The Role of Patient Preference and Interactions With Physicians

Mandelblatt, Jeanne S.; Sheppard, Vanessa B.; Hurria, Arti; Kimmick, Gretchen; Isaacs, Claudine; Taylor, Kathryn L.; Kornblith, Alice B.; Noone, Anne Michelle; Luta, George; Tallarico, Michelle; Barry, William T.; Hunegs, Lisa; Zoň, Robin; Naughton, Michael; Winer, Eric P.; Hudis, Clifford A.; Edge, Stephen B.; Cohen, Harvey Jay; Muss, Hyman B.

doi:10.1200/jco.2009.24.3295

Cited by 76 publications

(70 citation statements)

References 63 publications

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“…The results of the current study suggest that the majority of older survivors of breast cancer maintain high self‐reported cognitive function, but that chemotherapy (with or without hormonal treatment), which was received by the healthiest older survivors,23 can have adverse long‐term effects in a small number of survivors. This finding was independent of emotional and other factors and, if confirmed, highlights the importance of integrating cognitive function assessment into survivorship care for older survivors.…”

Section: Discussionmentioning

confidence: 78%

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Mandelblatt

Clapp

Luta

et al. 2016

Cancer

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138

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BACKGROUNDThe number of survivors of breast cancer aged ≥65 years (“older”) is growing, but to the authors' knowledge, little is known regarding the cognitive outcomes of these individuals.METHODSA cohort of cognitively intact older survivors with nonmetastatic, invasive breast cancer was recruited from 78 sites from 2004 through 2011; approximately 83.7% of the survivors (1280 survivors) completed baseline assessments. Follow‐up data were collected at 6 months and annually for up to 7 years (median, 4.1 years). Cognitive function was self‐reported using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30); scores ranged from 0 to 100, with a higher score indicating better function. Group‐based trajectory modeling determined trajectories; women were assigned to a trajectory group based on the highest predicted probability of membership. Multinomial logistic regression evaluated the association between receipt of chemotherapy (with or without hormonal treatment) and trajectory group.RESULTSSurvivors were aged 65 to 91 years; approximately 41% received chemotherapy. There were 3 cognitive trajectories: “maintained high” (42.3% of survivors); “phase shift” (50.1% of survivors), with scores slightly below but parallel to maintained high; and “accelerated decline” (7.6% of survivors), with the lowest baseline scores and greatest decline (from 71.7 [standard deviation, 19.8] to 58.3 [standard deviation, 21.9]). The adjusted odds of being in the accelerated decline group (vs the maintained high group) were 2.1 times higher (95% confidence interval, 1.3‐3.5) for survivors who received chemotherapy (with or without hormonal therapy) versus those treated with hormonal therapy alone. Greater comorbidity and frailty also were found to be associated with accelerated decline.CONCLUSIONSTrajectory group analysis demonstrated that the majority of older survivors maintained good long‐term self‐reported cognitive function, and that only a small subset who were exposed to chemotherapy manifested accelerated cognitive decline. Future research is needed to determine factors that place some older survivors at risk of experiencing cognitive decline. Cancer 2016;122:3555–3563. © 2016 American Cancer Society

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Section: Discussionmentioning

confidence: 78%

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Mandelblatt

Clapp

Luta

et al. 2016

Cancer

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138

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“…18,19 The study was conducted at 78 hospitals or practices affiliated with the Cancer and Leukemia Group B (CALGB) cooperative group, presently part of the Alliance for Clinical Trials in Oncology. 18 The protocol met Health Insurance Portability and Accountability Act standards and was approved by CALGB and the institutional review boards at all sites.…”

Section: Methodsmentioning

confidence: 99%

“…Also, several factors could have limited the representativeness and variability of the observed range of frailty scores, including the exclusion of women with cognitive impairment, healthy volunteer effects, and the cooperative group setting. 18 These constraints are likely to underestimate the true effects of frailty on noninitiation in the general older population of patients with breast …”

Section: 41mentioning

confidence: 99%

Frailty and Adherence to Adjuvant Hormonal Therapy in Older Women With Breast Cancer: CALGB Protocol 369901

Sheppard

Faul

Luta

et al. 2014

JCO

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Purpose Most patients with breast cancer age ≥ 65 years (ie, older patients) are eligible for adjuvant hormonal therapy, but use is not universal. We examined the influence of frailty on hormonal therapy noninitiation and discontinuation. Patients and Methods A prospective cohort of 1,288 older women diagnosed with invasive, nonmetastatic breast cancer recruited from 78 sites from 2004 to 2011 were included (1,062 had estrogen receptor–positive tumors). Interviews were conducted at baseline, 6 months, and annually for up to 7 years to collect sociodemographic, health care, and psychosocial data. Hormonal initiation was defined from records and discontinuation from self-report. Baseline frailty was measured using a previously validated 35-item scale and grouped as prefrail or frail versus robust. Logistic regression and proportional hazards models were used to assess factors associated with noninitiation and discontinuation, respectively. Results Most women (76.4%) were robust. Noninitiation of hormonal therapy was low (14%), but in prefrail or frail (v robust) women the odds of noninitiation were 1.63 times as high (95% CI, 1.11 to 2.40; P = .013) after covariate adjustment. Nonwhites (v whites) had higher odds of noninitiation (odds ratio, 1.71; 95% CI, 1.04 to 2.80; P = .033) after covariate adjustment. Among initiators, the 5-year continuation probability was 48.5%. After adjustment, the risk of discontinuation was higher with increasing age (P = .005) and lower for stage ≥ IIB (v stage I) disease (P = .003). Conclusion Frailty is associated with noninitiation of hormonal therapy, but it does not seem to be a major predictor of early discontinuation in older patients.

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“…Therefore, the goal of this research was to assess the associations between receipt of RS testing and subsequent chemotherapy use and medical expenditures in a population-based cohort of patients with early-stage breast cancer during years when RS testing became widespread (2007 to 2010). Because adjuvant chemotherapy use is strongly correlated with patients' age, [17][18][19] we also investigated whether the association between RS testing and chemotherapy use varied with age.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

Epstein

Wong

Mitra

et al. 2015

JCO

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We assessed the associations between the 21-gene recurrence score assay (RS) receipt, subsequent chemotherapy use, and medical expenditures among patients with early-stage breast cancer. Patients and MethodsData from the Pennsylvania Cancer Registry were used to assemble a retrospective cohort of women with early-stage breast cancer from 2007 to 2010 who underwent initial surgical treatment. These data were merged with administrative claims from the 12-month periods before and after diagnosis to identify comorbidities, treatments, and expenditures (n = 7,287). Propensity scoreweighted regression models were estimated to identify the effects of RS receipt on chemotherapy use and medical spending in the year after diagnosis. ResultsThe associations between RS receipt and outcomes varied markedly by patient age. RS use was associated with lower chemotherapy use among women younger than 55 (19.2% lower; 95% CI, 10.6 to 27.9). RS use was associated with higher chemotherapy use among women 75 to 84 years old (5.7% higher; 95% CI, 0.4 to 11.0). RS receipt was associated with lower adjusted 1-year medical spending among women younger than 55 ($15,333 lower; 95% CI, $2,841 to $27,824) and with higher spending among women who were 75 to 84 years old ($3,489 higher; 95% CI, $857 to $6,122). ConclusionRS receipt was associated with reduced use of adjuvant chemotherapy and lower health care spending among women with breast cancer who were younger than 55. Conversely, among women 75 and older, RS testing was associated with a modest increase in chemotherapy use and slightly higher spending. From a population perspective, the impact of RS testing on breast cancer treatment and health care costs is much greater in younger women.

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Breast Cancer Adjuvant Chemotherapy Decisions in Older Women: The Role of Patient Preference and Interactions With Physicians

Cited by 76 publications

References 63 publications

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Long‐term trajectories of self‐reported cognitive function in a cohort of older survivors of breast cancer: CALGB 369901 (Alliance)

Frailty and Adherence to Adjuvant Hormonal Therapy in Older Women With Breast Cancer: CALGB Protocol 369901

Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

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