Guideline-concordant chemotherapy in patients with hormone receptor-positive and node-positive, early breast cancer leads to better overall and metastases-free survival with limited benefit in elderly patients

Abstract

Purpose The German guideline for breast cancer recommends using chemotherapy (CHT) in patients with hormone receptorpositive and node-positive, invasive breast cancer. The aim of this study was to analyse the effects of CHT in this patient group on overall survival (OS) and distant metastases-free survival (DMFS), especially considering the 70-year threshold. Methods 1772 patients from the clinical cancer registry Regensburg (Germany) with hormone receptor-positive and nodepositive, invasive breast cancer diagnosed between 2003 and 2013 were analysed in a retrospective cohort study. OS and DMFS were evaluated by means of Kaplan-Meier and multivariable Cox-regression method. Results were further examined according to age at diagnosis. Results The comparison of 1544 patients with CHT to 228 patients without CHT showed a significant benefit for CHT regarding 5-year OS (91.3% vs. 76.8%) and 5-year DMFS (86.7% vs. 74.4%, both p < 0.001). Likewise, better OS and DMFS were seen in patients aged < 70 years using CHT compared to patients without CHT of the same age. Patients aged ≥ 70 years with CHT had a minimal benefit regarding 5-year OS compared to patients without CHT, but no advantage considering DMFS. All results were confirmed in multivariable analyses except for patients being ≥ 70 years of age. Conclusion Patients with hormone receptor-positive and node-positive, invasive breast cancer benefit from chemotherapy with regard to a significantly better overall and distant metastases-free survival, although chemotherapy use in patients aged ≥ 70 years results in a smaller benefit considering OS and no benefit considering DMFS.

Evaluating and Balancing the Risk of Breast Cancer-Specific Death and Other Cause-Specific Death in Elderly Breast Cancer Patients

“…After weighted, we found that chemotherapy improved survival, especially in women aged 70-74 years, but not significantly in women 75 years or older. These results are similar to those in other studies that have shown benefit of chemotherapy in appropriately selected patients (15)(16)(17)(18), but that the benefit decreases with aging (19,20). At the same time, the physiologic changes of aging increase the risk of adverse effects, together with an increased risk of hospitalization (21).…”

Effekte der gesetzlichen Qualitätssicherung in der akutstationären Versorgung

“…Andere Studien aus Deutschland konnten zeigen, dass positive Ausprägungen von Prozessqualitätsindikatoren mit positiven Ergebnissen für Patienten assoziiert sind. Beispielhaft genannt werden sollen hierzu aktuelle Analysen aus dem Traumaregister, einem klinischen Krebsregister und den Schlaganfallregistern, die jedoch alle nicht zu den verpflichtenden QS-Maßnahmen zählen [ 18 – 20 ]. Aber auch anhand von Daten der eQS konnte gezeigt werden, dass positive Indikatorausprägungen mit besseren Versorgungsstrukturen und auch besseren Patientenerfahrungen einhergehen [ 21 ].…”

The association between guideline adherence, age and overall survival among women with non-metastatic breast cancer: A systematic review

“…Sixty-seven papers were selected for full-text review; 64 from the electronic databases and three were selected from the reference list of an earlier systematic review [24]. Of these, 16 papers met the study eligibility criteria [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. The stages of the study selection are presented in Figure 1.…”

“…Table 1 summarises the characteristics of the 16 publications. The papers had adopted three main study designs: population-based cohort studies which used cancer registry databases (N = 8) [31-35, 37, 38, 42], multi-centre cohort studies (N = 5) [27,36,[39][40][41], or case series which used data from single institution databases (N = 3) [28][29][30]. Ten studies [27,29,31,32,35,[37][38][39][40][41] reviewed adherence to clinical guidelines, whilst six [28,30,33,34,36,42] used quality indicators or standards.…”