Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Hébert‐Croteau, Nicole; Brisson, Jacques; Latreille, Jean; Blanchette, Caty; Deschênes, L

doi:10.1002/(sici)1097-0142(19990301)85:5<1104::aid-cncr14>3.3.co;2-t

Cited by 32 publications

(37 citation statements)

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“…In our population, the proportion of patients treated in accordance with the guideline fell since 1998, following the introduction of the SNB, frequently due to omission of ALND. Several studies have reported lower use of ALND and postoperative radiotherapy in the elderly patient (Voogd et al, 1994;Guadagnoli et al, 1998a;Hebert-Croteau et al, 1999;Edge et al, 2002;Giordano et al, 2005). The benefit of ALND for elderly patients has been seriously questioned in the literature (Wazer et al, 1994;Newlin et al, 2002;Martelli et al, 2003) and surgeons may be reluctant to perform an additional ALND (following BCS or SNB) in elderly patients as they frequently suffer from comorbidity.…”

Section: As Reference)mentioning

confidence: 44%

“…In our study, 39% of the patients treated with an MRM for whom radiotherapy was indicated according to this guideline actually were not irradiated. Comorbidity and older age have previously been associated with decreased use of locoregional radiotherapy (Ballard-Barbash et al, 1996;Hebert-Croteau et al, 1999;Morrow et al, 2001). There is a need for guidelines, which better address treatment issues in the elderly breast cancer patient, especially as the elderly comprise a growing proportion of our patient populations.…”

Section: As Reference)mentioning

confidence: 99%

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Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

et al. 2005

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This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I -IIIA breast cancer patients diagnosed in 1989 -2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged X75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not have an ALND. Guideline compliance for BCS, with respect to radiotherapy and ALND, fell since the SNB introduction, from 96.1% before 2000 to 91.4% in 2002 (Po0.001). Noncompliance may however reflect patient-tailored medicine, as for elderly patients with small, radically resected primary tumours. The considerable variation in BCS-rates is more consistent with variations in surgeon preferences than patient's choice.

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confidence: 44%

Section: As Reference)mentioning

confidence: 99%

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

et al. 2005

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“…30,31 In brief, patients with breast cancer living in various regions of Quebec were randomly selected from the Quebec tumour registry for the periods Apr. 1 to Mar.…”

Section: Methodsmentioning

confidence: 99%

Early-stage breast cancer

Susman¹

2006

Oncology Times

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Background: The influence of organizational factors on the process and outcomes of the treatment of breast cancer has been extensively investigated. Although the quality of care is presumed to be better in larger centres, evidence is inconsistent. This study was conducted to determine whether therapies for patients with breast cancer varied according to hospital caseload. Methods: Women newly diagnosed between 1988 and 1994 with early-stage node-negative primary breast cancer were randomly selected from the Quebec tumour registry and the Quebec hospital discharge database. Data were collected from medical charts, and only women having undergone dissection of the axilla were included in the analyses. Logistic regression analysis was used to adjust for case mix and organizational variables. Results: The final sample included 1259 patients with node-negative stage I or II primary breast cancer. The proportion of women who underwent breast-conserving surgery increased significantly with hospital caseload (from 78.0% in hospitals admitting fewer than 25 new cases each year to 88.0% in those admitting 100 patients or more; p for trend < 0.001). This trend remained significant even after statistical adjustment for case mix and organizational factors (p for trend = 0.001). Of the 1039 women who underwent breast-conserving surgery 965 (92.9%) received radiotherapy. Use of systemic adjuvant therapy (tamoxifen or chemotherapy, or both) increased with the number of patients treated in a given centre (from 60.1% to 68.5%), but this trend disappeared after adjustment for case mix and other factors. The proportion of patients receiving systemic adjuvant therapy consistent with published consensus guidelines tended to increase with caseload for those treated in hospitals participating in multicentre clinical trials but decrease with caseload for patients in hospitals not involved in clinical research. Interpretation: The care of patients in Quebec with early-stage breast cancer is characterized by a high prevalence of both breast-conserving surgery and systemic adjuvant therapy. Large centres, especially those actively involved in clinical research, rapidly adopt innovative therapeutic modalities.

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“…The worldwide metaanalysis of randomized trials of adjuvant tamoxifen reported significant survival benefits in patients 70 years old or older diagnosed with ERϩ or ER-indeterminate tumors. 5 Few studies have investigated patterns of adjuvant tamoxifen use in older women 4,13,14 and we are aware of no study that has evaluated patterns in very old women. In this report, we describe demographic, disease, and treatment characteristics of primary breast carcinoma patients aged 80 and older.…”

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confidence: 92%

“…1 Age-dependent variations in care might partly explain differential breast carcinoma outcomes in older patients. Older women receive less aggressive breast carcinoma therapy, independent of their comorbid disease, 3,4 although age alone does not modify the effective-ness of treatment. 5 A recent study of U.S. women aged 67 and older diagnosed with localized breast carcinoma reported that women 80 and older were about three times less likely to receive guideline primary tumor therapy, by not receiving radiation therapy following breast-conserving surgery (BCS), compared with women 67-79 years of age after adjustment for covariates.…”

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confidence: 99%

Advanced age and adjuvant tamoxifen prescription in early‐stage breast carcinoma patients

Blackman

Lash

Fink

et al. 2002

Cancer

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BACKGROUNDAdjuvant tamoxifen is recommended for all women with estrogen receptor‐positive breast carcinoma without regard for age. We investigated age‐dependent variations in adjuvant tamoxifen prescription patterns in a cohort of women 80 years of age and older.METHODSWe studied 92 women diagnosed at four U.S. sites with primary, early‐stage breast carcinoma. Each woman consented to a medical record review and participated in two telephone interviews. We compared the proportion of tamoxifen prescriptions received by women 85–92 years of age with those received by women 80–84 years of age. Relative risks (RR) and 95% confidence intervals (95% CI) were generated using generalized estimating equations. Confounding by demographic, disease, and treatment characteristics was assessed.RESULTSBefore adjustment, patients 85–92 years of age were 28% less likely to receive a tamoxifen prescription compared with patients 80–84 years of age (RR = 0.72, 95% CI 0.57–0.91). In this sample, patients not prescribed tamoxifen had substantially more comorbidity. After adjusting the crude finding for comorbidity, the RR was 0.74 (95% CI 0.58–0.93). In addition, the oldest patients and those not prescribed tamoxifen were significantly less likely to be married or have living children. After adjusting the crude finding for these two factors, the RR was 0.75 (95% CI 0.59–0.95). There was no confounding by the other demographic, disease, or treatment covariates assessed.CONCLUSIONGiven the increasing longevity of the oldest old, undertreatment with adjuvant tamoxifen may put older breast carcinoma patients at an increased risk of disease recurrence and breast carcinoma mortality. Cancer 2002;95:2465–72. © 2002 American Cancer Society.DOI 10.1002/cncr.10985

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Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women

Cited by 32 publications

References 30 publications

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

Early-stage breast cancer

Advanced age and adjuvant tamoxifen prescription in early‐stage breast carcinoma patients

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