Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors

Abstract

PurposeCancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment.MethodsWe retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).ResultsWe identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6).ConclusionLong-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.

Determinants of Weight Gain During Adjuvant Endocrine Therapy and Association of Such Weight Gain With Recurrence in Long-term Breast Cancer Survivors

“…Using the Breast Cancer Management System database in the Department of Breast Medical Oncology at MD Anderson, we identified 1,282 women who were diagnosed with early stage (I-III), hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative BC between January 1997 and August 2008 and who received their initial treatment at MD Anderson to help diminish a selection bias. 27 HR-positive tumors were those that were either estrogen receptor–positive or progesterone receptor–positive as determined by immunohistochemistry using institutional cut-offs. HER2 status had been assessed by immunohistochemistry or by fluorescence in situ hybridization when available and determined to be positive or negative on the basis of institutional cut-offs and guidelines that were current at the time of diagnosis.…”

Genetic Counseling Referral Rates in Long-Term Survivors of Triple-Negative Breast Cancer

“…To avoid selection bias, we included those who had received their initial treatment and subsequent surveillance visits at MDACC and excluded those who had presented only for an initial consultation or a second opinion. 12…”

Influencers of the Decision to Undergo Contralateral Prophylactic Mastectomy among Women with Unilateral Breast Cancer

“…Using the prospectively maintained Breast Cancer Database Management System housed and curated in the Department of Breast Medical Oncology at the University of Texas MD Anderson Cancer Center, we identified women diagnosed with early stage breast cancer (stage 0-III) who underwent CPM between January 2010 and December 2017 with no clinical or radiographic evidence of contralateral breast cancer. Excluded from the study were women who had bilateral breast cancer before undergoing CPM, had received any treatment for breast cancer before their initial visit to MD Anderson Cancer Center, were BRCA1 or BRCA2 mutation carriers as well as other relevant mutations including CHEK2, TP53, ATM, PALB2, PTEN, and CDH1 , which are associated with familial breast cancers, or had presented for a second opinion and not to pursue management at our center [ 16 ].…”