Primary endocrine therapy as a treatment for older women with operable breast cancer – A comparison of randomised controlled trial and cohort study findings

Morgan, Jenna; Reed, Malcolm; Wyld, Lynda

doi:10.1016/j.ejso.2014.02.224

Cited by 67 publications

(46 citation statements)

References 61 publications

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“…29 Nevertheless, a Cochrane Review concluded that surgery for the elderly with ER positive early breast cancer gives better local control, and that primary endocrine therapy (PET) should be reserved for patients with significant comorbid disease or who refuse surgery. 30,31 When PET is used in the appropriate setting the outcome is satisfactory, and although Hille et al found that, of those patients initially considered unfit for or who declined surgery, 39% eventually had an operation, 32 that was not the finding in the present study.…”

Section: Discussioncontrasting

confidence: 62%

A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Bates

Evans

Lagord

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Funding: There was no specific funding for this study. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ςαριατιον ιν Προγνοσισ ς28 17 10 2013.δοχξ 2 *Manuscript Click here to view linked References AbstractBackground: Deprivation, non-white ethnicity and young age are associated with late

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Section: Discussioncontrasting

confidence: 62%

A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Bates

Evans

Lagord

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…Select prior studies demonstrate undertreatment of elderly patients leading to worse cancer outcomes, and appropriate treatment improving overall survival and quality of life even in patients with comorbidity and poor performance status (10,34–37). Yet other studies demonstrate older patients facing measurably increased toxicity (and mortality) risks associated with a variety of cancer treatment modalities (33,38–40).…”

Section: Discussionmentioning

confidence: 99%

Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

Fang

Gomez

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Background We examined frequency of guideline-concordant cancer care in elderly patients, including “older” elderly (age≥80). Methods Using the Surveillance, Epidemiology and End Results-Medicare dataset in patients age≥66 years, diagnosed with non-metastatic breast (n=55,094), non-small cell lung (NSCLC) (n=36,203), or prostate (n=86,544) cancer from 2006–2011, chemotherapy, surgery, and radiation (RT) treatments were identified using claims. Pearson chi-square tested associations between age and guideline concordance. Results Older patients were less likely to receive guideline-concordant curative treatment: in Stage III breast cancer, receipt of post-mastectomy RT (70%, 46% and 21% in patients age 66–79, 80–89 and ≥90 respectively; P<0.0001); in Stage I NSCLC, RT or surgery (89%, 80%, and 64% in age 66–79, 80–89 and ≥90; P<0.0001); in Stage III NSCLC, RT or surgery plus chemotherapy (79%, 58%, and 27% in age 66–79, 80–89 and ≥90; P<0.0001); and in intermediate/high risk prostate cancer, RT or prostatectomy (projected life expectancy >10 yrs—85% and 82% in age 66–69 and 70–75; and ≤10 years—70%, 42%, and 9% in age 76–79, 80–89, ≥90; P<0.0001). However, older patients were more likely to receive guideline-concordant de-intensified treatment: in Stage I–II node-negative breast cancer, hypofractionated post-lumpectomy RT (9%, 16% and 23% in age 66–79, 80–89 and ≥90; P<0.0001); in stage I ER+ breast cancer, observation after lumpectomy (12%, 42%, and 84% in age 66–79, 80–89 and ≥90; P<0.0001); in stage I NSCLC, stereotactic body RT instead of surgery (7%, 16%, and 25% in age 66–79, 80–89 and ≥90; P<0.0001); and in lower-risk prostate cancer, no active treatment (25%, 54%, and 68% in age 66–79, 80–89 and ≥90; P<0.0001). Conclusion Actual treatment of older elderly cancer patients frequently diverged from guidelines, especially in curative treatment of advanced disease. Results suggest a need for better metrics than existing guidelines alone to evaluate quality and appropriateness of care in this population.

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“…This corroborates the findings by Wylie et al [20] and is most likely due to a lack of guidelines on its usage. A recent review on this subject advocates the use of AIs for PET, unless otherwise contraindicated [27] but there have been no studies that determine how best to follow these patients up. The involvement of geriatricians and the use of CGA in the assessment of older patients is also recommended [19], however few HCPs had access to this type of service.…”

Section: The Uk S Depa T E T Of Health Esta Lished the Natio Al Ca mentioning

confidence: 99%

Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer

Morgan¹,

Collins²,

Robinson³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Primary endocrine therapy as a treatment for older women with operable breast cancer – A comparison of randomised controlled trial and cohort study findings

Abstract: Guidelines to aid selection are needed but PET should be reserved for patients with reduced predicted life expectancy (e.g. less than five years), with AIs being preferable over Tamoxifen.

Cited by 67 publications

References 61 publications

A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States

Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer

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