Does Guideline-Adherent Therapy Improve the Outcome for Early-Onset Breast Cancer Patients?

Abstract

Background and Objective: Guidelines for the treatment of early-onset breast cancer have been proposed in several countries, but to date, their impact on outcomes is unverified. The objective of this study was to evaluate the association between guideline-adherent versus nonadherent treatment and recurrence-free survival (RFS) and overall survival (OAS) in early-onset breast cancer patients. Methods: A total of 1,778 patients were included in the study, of whom 111 were 35 years or younger and 1,667 were between 36 and 55 years. RFS and OAS were compared between the two groups, with respect to multiple parameters. All survival data were adjusted for tumor characteristics and analyzed with respect to guideline adherence according to the German Step 3 guidelines. Results: Statistically significant differences between the two groups (<35 years, 36–55 years) were observed with regard to breast surgery (p = 0.002) and hormone therapy (p = 0.006). Both groups were treated identically in terms of guideline adherence concerning axillary dissection (p = 0.9), radiation therapy (p = 0.7) and chemotherapy (p = 0.556). Young breast cancer patients whose treatment adhered to guideline recommendations had increased RFS and OAS [RFS: p = 0.030, hazard ratio (HR) 2.95, 95% confidence interval (CI) 1.11–7.83; OAS: p ≤ 0.001, HR 2.92, 95% CI 2.01–4.23]. Conclusion: Guideline-adherent treatment for early-onset breast cancer patients significantly improves OAS and RFS and should therefore be demanded for all patients.

Predictors of state-of-the-art management of early breast cancer in Switzerland

“…No significant differences in total or surgical subscores were observed between patients operated by surgeons in the intermediate (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) …”

“…Characteristics of both patients and health care providers [8] have been related to these variations. Hospital and physician volume [9], specialization [10,11], participation in research [9], multidisciplinary teams [12] and treatment in accordance to guidelines [13] have been found to affect both the way patients are cared for and the outcomes. Variations in treatment include type of breast and axillary surgery, and use of chemotherapy, hormone therapy and radiation therapy.…”

Guideline Conformity Treatment in Young Women with Early-Onset Breast Cancer in Germany

“…About every 10th woman diagnosed with BC in Germany is younger than 45 years [1]. Younger women are often affected by a more aggressive form of this disease [2,3]. When treating this young population, special factors have to be taken into consideration: long recurrence-free survival (RS) and overall survival (OS) have to be weighed against quality of life and reintegration into family and work life.…”

Is Guideline Adherence the Key to Increased Survival in Patients with Breast Cancer?

“…We read with interest the article by Varga et al recently published in Oncology [1]. Using data of 1,778 patients with early onset breast cancer (55 years or younger), the authors reported that guideline adherence to surgical treatment, radiotherapy, anti-estrogen/endocrine therapy and chemotherapy significantly improved overall survival.…”

“…As in the study of Varga et al [1], information on the operationalization of ‘guideline adherence’ is sparse, it is difficult to assess to which magnitude the above-mentioned methodological issues may have biased the results. Other publications that used the same database to address the influence of guideline adherence on mortality did not provide substantially more information on the methods used [7,8,9,10].…”