Perspectives and Attitudes on the Use of Adjuvant Chemotherapy and Trastuzumab in Older Adults with HER-2+ Breast Cancer: A Survey of Oncologists

Hurria, Arti; Wong, F. Lennie; Pal, Sumanta K.; Chung, Charles S.; Bhatia, Smita; Mortimer, Joanne; Hurvitz, Sara A.; Villaluna, Doojduen; Naeim, Arash

doi:10.1634/theoncologist.2009-0056

Cited by 21 publications

(6 citation statements)

References 17 publications

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“…Our data show that the decision to take this treatment approach is clearly associated with expected characteristics, such as older age or worse general health status, and less aggressive histology, rather than tumor stage. These results from real-world data reflect findings for hypothetical cases presented to US oncologists in a survey asking for treatment recommendations in older adults with HER2-positive EBC [ 24 ].…”

Section: Discussionsupporting

confidence: 71%

Trastuzumab without chemotherapy in the adjuvant treatment of breast cancer: subgroup results from a large observational study

et al. 2018

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Section: Discussionsupporting

confidence: 71%

Trastuzumab without chemotherapy in the adjuvant treatment of breast cancer: subgroup results from a large observational study

et al. 2018

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“…While prognostic models have included age as an adverse factor in lymphomas (The International Non‐Hodgkin's Lymphoma Prognostic Factors Project, ; Solal‐Celigny et al , ), studies that have led to this conclusion included few patients >80 years and were conducted before the modern chemoimmunotherapy era. Whether old age affects outcome due to different disease biology in the elderly or due to older patients being treated less aggressively remains unknown (Hurria et al , ). Another factor that could affect outcome in the elderly patient population is dose density and intensity.…”

Section: Discussionmentioning

confidence: 99%

Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma‐related mortality in elderly follicular lymphoma in the United States

Nabhan

Byrtek²,

Rai

et al. 2015

Br J Haematol

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Summary Data from the National LymphoCare Study (a prospective, multicentre registry that enrolled follicular lymphoma (FL) patients from 2004–2007) were used to determine disease characteristics, treatment patterns, outcomes and prognosis for elderly FL (eFL) patients. Of 2650 FL patients, 209 (8%) were aged >80 years; these eFL patients more commonly had grade 3 disease, less frequently received chemoimmunotherapy and anthracyclines, and had lower response rates when compared to younger patients. With a median follow-up of 6.9 years, 5-year overall survival (OS) for eFL patients was 59%; 38% of deaths were lymphoma-related. No treatment produced superior OS among eFL patients. In multivariate Cox models, anaemia, B-symptoms and male sex predicted worse OS (P < 0·01); a prognostic index of these factors (0, 1 or ≥2 present) predicted OS (hazard ratio [95% confidence interval]: ≥2 vs. 0, 4·72 [2·38–9·33], ; 1 vs. 0, 2·63 [1·39–4·98]), with a higher concordance index (0·63) versus the Follicular Lymphoma International Prognostic Index (0·55). The index was validated in an independent cohort. In the largest prospective US-based eFL cohort, no optimal therapy was identified and nearly 40% of deaths were lymphoma-related, representing baseline outcomes in the modern era.

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“…Previous analyses using the acquired dataset have explored differences in treatment recommendations amongst these two respondent categories, and have further addressed oncologists’ recommendations for patients with HER2-overexpressing disease. 18,19 In the current analysis, responses from oncologists were assessed with respect to treatment recommendations for hormone receptor positive, non-HER2-overexpressing disease. Candidates for the survey study were identified using the American Medical Association (AMA) member database.…”

Section: Methodsmentioning

confidence: 99%

Oncologists' Recommendations for Adjuvant Therapy in Hormone Receptor—Positive Breast Cancer Patients of Varying Age and Health Status

Naeim

Wong

Pal

et al. 2010

Clinical Breast Cancer

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Introduction Currently, evidence supports the use of adjuvant endocrine therapy with aromatase inhibitors in postmenopausal patients with hormone-receptor positive breast cancer. The goal of the current study is to understand the impact of patient age and health status on the decision of the oncologist to recommend adjuvant endocrine therapy (with or without chemotherapy) in older women with hormone-receptor positive breast cancer. Methods An on-line survey was conducted, with questions related to treatment of a hypothetical patient of varying age and health status with a T2N2 hormone-receptor positive, HER2-negative breast cancer. Treatment options included chemotherapy and endocrine therapy, endocrine therapy alone, or no therapy. With recommendation of endocrine therapy, respondents were further asked to specify use of either tamoxifen or aromatase inhibitors. A generalized linear mixed-effects model was used to determine the impact of age and health status on treatment recommendations. Results As the hypothetical patient’s age increased or health status deteriorated, oncologists were less likely to recommend a combination of chemotherapy and endocrine therapy (P<0.0001 for both). In contrast, oncologists were more likely to recommend endocrine therapy alone with advanced age (P<0.0001) and deteriorating health status (P<0.0001). With respect to the type of endocrine therapy selected, oncologists were more likely to choose treatment with aromatase inhibitors as opposed to tamoxifen (P<0.01), irrespective of age or health status. No therapy was infrequently recommended, constituting 2% of responses on average. Conclusions With increasing age and declining health status, oncologists were more likely to recommend treatment with endocrine therapy alone as opposed to the combination of chemotherapy with endocrine therapy. Oncologists were most likely to recommend use of aromatase inhibitors, irrespective of age or health status.

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Perspectives and Attitudes on the Use of Adjuvant Chemotherapy and Trastuzumab in Older Adults with HER-2+ Breast Cancer: A Survey of Oncologists

Cited by 21 publications

References 17 publications

Trastuzumab without chemotherapy in the adjuvant treatment of breast cancer: subgroup results from a large observational study

Trastuzumab without chemotherapy in the adjuvant treatment of breast cancer: subgroup results from a large observational study

Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma‐related mortality in elderly follicular lymphoma in the United States

Oncologists' Recommendations for Adjuvant Therapy in Hormone Receptor—Positive Breast Cancer Patients of Varying Age and Health Status

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