The Association between Age, Comorbidities and Use of Radiotherapy in Women with Breast Cancer: Implications for Survival

Abstract

Background: Radiotherapy (RT) plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of RT in this population. Methods: Patients diagnosed with breast cancer from 2004–2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients >65 years of age who received RT survived significantly longer than those who did not receive RT (aHR = 0.53, 95% CI = 0.52–0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted p-trend by age < 0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future.

21-Gene Recurrence Score Assay and Outcomes of Adjuvant Radiotherapy in Elderly Women With Early-Stage Breast Cancer After Breast-Conserving Surgery

“…There were 67.5–89% of patients still receipt of adjuvant RT after the Cancer and Leukemia Group B (CALGB) 9343 publication (5, 6), which was similar to our study. In addition, we found that receipt of postoperative RT improved BCSS compared with patients who did not have postoperative RT, data that are similar to results from two National Cancer Database (NCDB) studies (21, 22). Therefore, elderly patients for whom postoperative RT can be omitted safely should be investigated further.…”

Prognostic validation and treatment decision making of the 8th edition of the American Joint Committee on Cancer pathological staging system for elderly women with early-stage breast cancer

“…A recent study from nine European countries suggested that elderly patients should receive standard medical treatment whenever possible to maximize the benefits of modern evidence-based treatments [ 23 ]. Given the increased burden of comorbidities [ 24 ], frailty among elderly patients could lead to therapy delays or refusals, which might lead to lower survival rates [ 25 , 26 ]. In this study, only 20% of deaths were from BC, while cardiovascular, cerebrovascular, and lung diseases were common causes of death in elderly patients.…”

Pathologic Complete Response (pCR) and Survival of Women with Inflammatory Breast Cancer (IBC): An Analysis Based on Biologic Subtypes and Demographic Characteristics

“…The NCDB database has been previously described [37,38]. In brief, over 1500 Commission on Cancer (CoC) accredited cancer programs in the United States (US) report data to the NCDB, encompassing approximately 70% of incident cancer cases [39].…”