The characteristics, management and outcomes of older women with breast cancer in New Zealand

Blackmore, Tania; Lawrenson, Ross; Lao, Chunhuan; Edwards, Melissa; Kuper‐Hommel, Marion; Elwood, Mark; Campbell, Ian

doi:10.1016/j.maturitas.2018.03.018

Cited by 10 publications

(10 citation statements)

References 43 publications

(68 reference statements)

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“…As noted above women who had diabetes were more likely to be older, be Māori, Pacific or Asian and have more comorbidities than women without diabetes. Previous studies have shown that older age and more comorbidities are significantly associated with decreasing use of surgery [3,[24][25][26]. Therefore, after adjustment for age, comorbidities and other factors, the gap in use of surgery for breast cancer between the diabetes group and the non-diabetes group narrowed, and the difference was only significant for women with stage I breast cancer.…”

Section: Discussionmentioning

confidence: 93%

Impact of diabetes on surgery and radiotherapy for breast cancer

Lawrenson

Lao

Stanley

et al. 2023

Breast Cancer Res Treat

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Purposes This study aims to examine whether diabetes has an impact on the use of surgery and adjuvant radiotherapy in treating women with localised breast cancer. Methods Women diagnosed with stage I–III breast cancer between 2005 and 2020 were identified from Te Rēhita Mate Ūtaetae—Breast Cancer Foundation New Zealand National Register, with diabetes status determined using New Zealand’s Virtual Diabetes Register. The cancer treatments examined included breast conserving surgery (BCS), mastectomy, breast reconstruction after mastectomy, and adjuvant radiotherapy after BCS. Logistic regression modelling was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) of having cancer treatment and treatment delay (> 31 days) for patients with diabetes at the time of cancer diagnosis compared to patients without diabetes. Results We identified 25,557 women diagnosed with stage I–III breast cancer in 2005–2020, including 2906 (11.4%) with diabetes. After adjustment for other factors, there was no significant difference overall in risk of women with diabetes having no surgery (OR 1.12, 95% CI 0.94–1.33), although for patients with stage I disease not having surgery was more likely (OR 1.45, 95% CI 1.05–2.00) in the diabetes group. Patients with diabetes were more likely to have their surgery delayed (adjusted OR of 1.16, 95% CI 1.05–1.27) and less likely to have reconstruction after mastectomy compared to the non-diabetes group—adjusted OR 0.54 (95% CI 0.35–0.84) for stage I cancer, 0.50 (95% CI 0.34–0.75) for stage II and 0.48 (95% CI 0.24–1.00) for stage III cancer. Conclusions Diabetes is associated with a lower likelihood of receiving surgery and a greater delay to surgery. Women with diabetes are also less likely to have breast reconstruction after mastectomy. These differences need to be taken in to account when considering factors that may impact on the outcomes of women with diabetes especially for Māori, Pacific and Asian women.

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Section: Discussionmentioning

confidence: 93%

Impact of diabetes on surgery and radiotherapy for breast cancer

Lawrenson

Lao

Stanley

et al. 2023

Breast Cancer Res Treat

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“…Despite these findings, the role of postmastectomy radiation is not specific to subtype and often indicated for larger (T3) and node positive tumour, among other prognostic considerations. In the context of our results, the higher risk of locoregional and distant recurrence in early-onset patients may be driven by the fact that younger women are more likely to choose mastectomy [ 61 , 62 ] and may not be indicated for postmastectomy radiation for smaller, node negative disease. Cancello et al describe T1N0 disease as a spectrum from patients at very low risk for whom there is little evidence supporting the use of adjuvant therapy, to those with higher risk disease where an approach including chemotherapy plus targeted therapy appears clearly justified [ 63 ].…”

Section: Discussionmentioning

confidence: 96%

The Association between Early-Onset Diagnosis and Clinical Outcomes in Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis

Basmadjian

Chow

Kim

et al. 2023

Cancers

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Early-onset diagnosis, defined by age <40 years, has historically been associated with inferior outcomes in breast cancer. Recent evidence suggests that this association is modified by molecular subtype. We performed a systematic review and meta-analysis of the literature to synthesize evidence on the association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer (TNBC). Studies comparing the risk of clinical outcomes in non-metastatic TNBC between early-onset patients and later-onset patients (≥40 years) were queried in Medline and EMBASE from inception to February 2023. Separate meta-analyses were performed for breast cancer specific survival (BCSS), overall survival (OS), and disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and pathological complete response (pCR). In total, 7581 unique records were identified, and 36 studies satisfied inclusion criteria. The pooled risk of any recurrence was significantly greater in early-onset patients compared to later-onset patients. Better BCSS and OS were observed in early-onset patients relative to later-onset patients aged >60 years. The pooled odds of achieving pCR were significantly higher in early-onset patients. Future studies should evaluate the role of locoregional management of TNBC and the implementation of novel therapies such as PARP inhibitors in real-world settings, and whether they improve outcomes.

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“…This study found that the costs of stage I-III breast cancer were associ- younger women were more likely to be diagnosed with advanced cancer and more aggressive subtype, and they receive more treatment than older women. 18,19 Increasing age was associated with decreasing use of surgery, adjuvant radiotherapy, endocrine therapy, and chemotherapy, even after adjustment for stage and level of comorbidity. 18,19 Before adjustment for other factors, M āori and Pacific patients seemed to incur higher public healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Increasing age was associated with decreasing use of surgery, adjuvant radiotherapy, endocrine therapy, and chemotherapy, even after adjustment for stage and level of comorbidity. 18,19 Before adjustment for other factors, M āori and Pacific patients seemed to incur higher public healthcare costs. However, after adjustment, M āori patients had equivalent costs, and Pacific patients had lower costs than others for both stage I-III cancer and stage IV cancer.…”

Section: Discussionmentioning

confidence: 99%

What affects the public healthcare costs of breast cancer in New Zealand?

Lao

Mondal

Kuper‐Hommel

et al. 2022

Asia-Pac J Clncl Oncology

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Backgrounds The pressure to the healthcare system for providing ongoing monitoring and treatment for breast cancer survivors is increasing. This study aims to identify the factors that affect the public healthcare costs of stage I–III breast cancer and stage IV cancer in New Zealand. Methods We identified women diagnosed with invasive breast cancer between July 1, 2010 and June 30, 2018 and who received services in a public hospital. Patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry and were linked to the national administrative datasets. A two‐part model was used to identify the factors that affect the public healthcare costs of stage I–III breast cancer and stage IV cancer. Results We identified 16,977 stage I–III and 1,093 stage IV breast cancer patients eligible for this study. The costs of stage I–III cancer in the second to fifth year post diagnosis decreased over time, and the costs of stage IV cancer in the first year post diagnosis increased over time. After adjustment for other factors, the costs of stage I–IV cancer decreased with age but increased with cancer stage. HER2+ cancers had the highest costs, followed by triple negative cancers. After adjustment for other factors, Pacific and Asian women had lower costs, and Māori had similar costs compared to others. For stage I–III cancers, women living in nonmajor urban areas had a higher chance of incurring costs in follow‐up years, and screen detected patients and patients having any services in a private hospital had a decreased probability of receiving any public healthcare services. Conclusions Pacific women had higher costs than others, but after adjustment for cancer stage, subtype, and other factors, they had lower costs than others. The early detection and better management of stage I–III breast cancer can lead to better outcome and lower costs in follow‐up years.

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The characteristics, management and outcomes of older women with breast cancer in New Zealand

Cited by 10 publications

References 43 publications

Impact of diabetes on surgery and radiotherapy for breast cancer

Impact of diabetes on surgery and radiotherapy for breast cancer

The Association between Early-Onset Diagnosis and Clinical Outcomes in Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis

What affects the public healthcare costs of breast cancer in New Zealand?

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