Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

LeMasters, Traci; Madhavan, Suresh; Sambamoorthi, Usha; Hazard‐Jenkins, Hannah; Kelly, Kimberly A.; Long, Dustin

doi:10.6004/jnccn.2018.7004

Cited by 30 publications

(24 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Factors associated with treatment noncompliance. In agreement with previous studies, tumor characteristics (pre-surgical tumor size, grade, proxy subtype) and age at diagnosis were associated with initiation of recommended treatment [22][23][24] . Many factors can potentially influence a patient's decision to go along with recommended treatment: previous experiences and personal values 17 , fear of treatment-related side effects 18 , financial ability, age, education and health status, among others 19,20 .…”

Section: Discussionsupporting

confidence: 91%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80-2.83]), chemotherapy (1.25 [1.11-1.41]), radiotherapy (2.28 [1.94-2.69]) and endocrine therapy (1.70 [1.41-2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations. Breast cancer is the leading type of cancer among Asian women, with an increasing number of cases diagnosed every year 1. Between 2003 and 2008, there were more than 2 million women living with breast cancer in SouthEast Asia, where a population of over 650 million women resides 2. As breast cancer is common, the number of lives claimed by the disease is high. On average ~100,000 deaths from breast cancer were recorded every year in the same region 3. With significant progress in treatment and disease management, a growing number of women are surviving breast cancer 4. However, breast cancer survival can vary between countries. While 90% of patients in the United States live at least five years after the cancer is found 5 , the corresponding proportion is lower in SouthEast Asia. In a report by Bhoo-Pathy et al., five-year overall survival rates were estimated to range from 58.5% to 75.8% in SouthEast Asia 6. Several professional organizations and consensus groups exist to translate evidence-based medicine into recommendations for best patient care 7. Examples of providers of such clinical practice guidelines include the

show abstract

Section: Discussionsupporting

confidence: 91%

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Sim

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The most striking difference is observed for breast cancer; 89% of patients aged 65 to 84 years receive surgery compared with just 65% of those aged 85 years and older. Other studies have found that older patients with breast cancer are less likely to receive guideline‐concordant care, even after accounting for patient comorbidities . Moreover, older patients with cancer are not only less likely to receive surgery, but often receive little or no treatment at all .…”

Section: Selected Findingsmentioning

confidence: 99%

Cancer statistics for adults aged 85 years and older, 2019

DeSantis

Miller

Dale

et al. 2019

CA A Cancer J Clinicians

256

199

View full text Add to dashboard Cite

Adults aged 85 years and older, the “oldest old,” are the fastest‐growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.

show abstract

“…Previous studies showed that a substantial number of Americans receive less than optimal care . Widespread and equitable access to and utilization of high‐quality care (both preventive and therapeutic) is necessary to achieve the 2035 challenge goal of reducing cancer mortality from the 2015 level.…”

Section: Discussionmentioning

confidence: 99%

The American Cancer Society 2035 challenge goal on cancer mortality reduction

Jemal

Fedewa

et al. 2019

CA A Cancer J Clinicians

View full text Add to dashboard Cite

A summary evaluation of the 2015 American Cancer Society (ACS) challenge goal showed that overall US mortality from all cancers combined declined 26% over the period from 1990 to 2015. Recent research suggests that US cancer mortality can still be lowered considerably by applying known interventions broadly and equitably. The ACS Board of Directors, therefore, commissioned ACS researchers to determine challenge goals for reductions in cancer mortality by 2035. A statistical model was used to estimate the average annual percent decline in overall cancer death rates among the US general population and among college-educated Americans during the most recent period. Then, the average annual percent decline in the overall cancer death rates of college graduates was applied to the death rates in the general population to project future rates in the United States beginning in 2020. If overall cancer death rates from 2020 through 2035 nationally decline at the pace of those of college graduates, then death rates in 2035 in the United States will drop by 38.3% from the 2015 level and by 54.4% from the 1990 level. On the basis of these results, the ACS 2035 challenge goal was set as a 40% reduction from the 2015 level. Achieving this goal could lead to approximately 1.3 million fewer cancer deaths than would have occurred from 2020 through 2035 and 122,500 fewer cancer deaths in 2035 alone. The results also show that reducing the prevalence of risk factors and achieving optimal adherence to evidence-based screening guidelines by 2025 could lead to a 33.5% reduction in the overall cancer death rate by 2035, attaining 85% of the challenge goal. CA Cancer J Clin 2019;69:351-362.

show abstract

Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

Cited by 30 publications

References 34 publications

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Cancer statistics for adults aged 85 years and older, 2019

The American Cancer Society 2035 challenge goal on cancer mortality reduction

Contact Info

Product

Resources

About