Impact of omission of surgery on survival of older patients with breast cancer

Glas, Nienke A. de; Jonker, J.M.; Bastiaannet, E.; Craen, Anton J. M. de; Velde, Cornelis J.H. van de; Siesling, Sabine; Liefers, Gerrit‐Jan; Portielje, Johanneke E.A.; Hamaker, Marije E.

doi:10.1002/bjs.9616

Cited by 33 publications

(21 citation statements)

References 25 publications

(32 reference statements)

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“…New prediction models or improvements of currently available prediction models that can be used in older patients are therefore required, especially as breast cancer mortality increases with age ( van de Water et al , 2012 ). In contrast with younger patients, breast cancer mortality has not improved in older patients in the past decades ( Bastiaannet et al , 2011 ; de Glas et al , 2014b ). This may be explained by the fact that current guidelines are mostly based on studies that were performed in younger patients ( Wildiers et al , 2007 ), or in highly selected older populations ( van de Water et al , 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Validity of the online PREDICT tool in older patients with breast cancer: a population-based study

et al. 2016

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Background:Predicting breast cancer outcome in older patients is challenging, as it has been shown that the available tools are not accurate in older patients. The PREDICT tool may serve as an alternative tool, as it was developed in a cohort that included almost 1800 women aged 65 years or over. The aim of this study was to assess the validity of the online PREDICT tool in a population-based cohort of unselected older patients with breast cancer.Methods:Patients were included from the population-based FOCUS-cohort. Observed 5- and 10-year overall survival were estimated using the Kaplan–Meier method, and compared with predicted outcomes. Calibration was tested by composing calibration plots and Poisson Regression. Discriminatory accuracy was assessed by composing receiver-operator-curves and corresponding c-indices.Results:In all 2012 included patients, observed and predicted overall survival differed by 1.7%, 95% confidence interval (CI)=−0.3–3.7, for 5-year overall survival, and 4.5%, 95% CI=2.3–6.6, for 10-year overall survival. Poisson regression showed that 5-year overall survival did not significantly differ from the ideal line (standardised mortality ratio (SMR)=1.07, 95% CI=0.98–1.16, P=0.133), but 10-year overall survival was significantly different from the perfect calibration (SMR=1.12, 95% CI=1.05–1.20, P=0.0004). The c-index for 5-year overall survival was 0.73, 95% CI=0.70–0.75, and 0.74, 95% CI=0.72–0.76, for 10-year overall survival.Conclusions:PREDICT can accurately predict 5-year overall survival in older patients with breast cancer. Ten-year predicted overall survival was, however, slightly overestimated.

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Section: Discussionmentioning

confidence: 99%

Validity of the online PREDICT tool in older patients with breast cancer: a population-based study

et al. 2016

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“…Older patients with breast cancer frequently undergo breast amputation, while it is known that this will not influence overall survival. Therefore, other important factors such as illness perceptions should be included in the decision about the best treatment for these patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Illness Perceptions in Women with Breast Cancer—a Systematic Literature Review

Kaptein

Schoones²,

Fischer

et al. 2015

Curr Breast Cancer Rep

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Women with breast cancer respond to the illness and its medical management in their own personal way. Their coping behavior and self-management are determined by their views (cognitions) and feelings (emotions) about symptoms and illness: their illness perceptions. This paper reports the results of a systematic literature review of illness perceptions and breast cancer. In the 12 studies identified, published between 2012 and 2015, illness perceptions were found to be important concomitants of medical and behavioral outcomes: fear of recurrence, distress, quality of life, satisfaction with medical care, use of traditional healers, and risk perception. Intervention studies are called for where the effects are examined of replacing unhelpful illness perceptions by more constructive ones. Health care providers do well by incorporating illness perceptions in their care for women with breast cancer, as this is instrumental in improving patients’ quality of life.

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“…Nearly half of women aged ≥75 years will be diagnosed with breast cancer, and current trends indicate that standard-of-care treatment with breast-conserving surgery in this population is declining. 2 Historical data suggest very poor local control with hormone therapy alone and unacceptable toxicity with conventionally fractionated definitive whole-breast radiation therapy. 7 , 8 The need for novel treatment modalities to achieve effective local control and reduce treatment-related toxicity is growing.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Recent data suggest that surgical treatment of patients aged ≥75 years with stage I-III breast cancer has declined from 90.8% in 1995 to 69.9% in 2011. 2 Even in patients who undergo surgery, adjuvant therapy recommendations continue to be nebulous.…”

Section: Introductionmentioning

confidence: 99%

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Lischalk

Chen

Repka

et al. 2018

Advances in Radiation Oncology

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PurposeFew definitive treatment options exist for elderly patients diagnosed with early stage breast cancer who are medically inoperable or refuse surgery. Historical data suggest very poor local control with hormone therapy alone. We examined the dosimetric feasibility of hypofractionated radiation therapy using stereotactic ablative radiotherapy (SABR) and proton beam therapy (PBT) as a means of definitive treatment for early stage breast cancer.Methods and MaterialsFifteen patients with biopsy-proven early stage breast cancer with a clinically visible tumor on preoperative computed tomography scans were identified. Gross tumor volumes were contoured and correlated with known biopsy-proven malignancy on prior imaging. Treatment margins were created on the basis of set-up uncertainty and image guidance capabilities of the three radiation modalities analyzed (3-dimensional conformal radiation therapy [3D-CRT], SABR, and PBT) to deliver a total dose of 50 Gy in 5 fractions. Dose volume histograms were analyzed and compared between treatment techniques.ResultsThe median planning target volume (PTV) for SABR, PBT, and 3-dimensional CRT was 11.91, 21.03, and 45.08 cm3, respectively, and were significantly different (P < .0001) between treatment modalities. Overall target coverage of gross tumor and clinical target volumes was excellent with all three modalities. Both SABR and PBT demonstrated significant dosimetric improvements, each in its own unique manner, relative to 3D-CRT. Dose constraints to normal structures including ipsilateral/contralateral breast, bilateral lungs, and heart were all consistently achieved using SABR and PBT. However, skin or chest wall dose constraints were exceeded in some cases for both SABR and PBT plans and was dictated by the anatomic location of the tumor.ConclusionsDefinitive hypofractionated radiation therapy using SABR and PBT appears to be dosimetrically feasible for the treatment of early stage breast cancer. The anatomical location of the tumor relative to the skin and chest wall appears to be the primary limiting dosimetric factor.

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Impact of omission of surgery on survival of older patients with breast cancer

Abstract: Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.

Cited by 33 publications

References 25 publications

Validity of the online PREDICT tool in older patients with breast cancer: a population-based study

Validity of the online PREDICT tool in older patients with breast cancer: a population-based study

Illness Perceptions in Women with Breast Cancer—a Systematic Literature Review

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

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