Tumor biology in older breast cancer patients – What is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients

Ebner, Florian; Ewijk, Reyn van; Wöckel, Achim; Hancke, Katharina; Schwentner, Lukas; Fink, Visnja; Janni, Wolfgang; Blettner, Maria

doi:10.1016/j.breast.2015.02.029

Cited by 12 publications

(12 citation statements)

References 42 publications

(51 reference statements)

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“…Later tumor stages and more unfavorable tumor biology were also significantly more common in the oldest patients. These statements confirm the findings of other research (6)(7)(8). In fact, in the last 15 years the breast cancer-specific mortality rate in women aged over 69 years in…”

Section: Less Common As Age Increasessupporting

confidence: 91%

Treatment Quality in Breast Cancer

Nestle-Krämling¹,

Andree²

2015

Deutsches Ärzteblatt International

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Section: Less Common As Age Increasessupporting

confidence: 91%

Treatment Quality in Breast Cancer

Nestle-Krämling¹,

Andree²

2015

Deutsches Ärzteblatt International

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“…A direct association between adherence to breast cancer CGs and better overall survival was more frequently observed regardless of the study period [22], the use of different cut-offs or number of deviations to CGs recommendations used to determine adherence [17,42,48] and patient's age [17,18,37,41,44,45]. Although non-adherence was associated with lower survival rate both in triple negative breast cancer (TNBC) and non-TNBC patients, this association was stronger in TNBC than in non-TBNC patients [19,43]. Seven studies explored adherence by treatment modality [18,19,30,37,43,47,48], revealing that there was better overall survival in patients receiving CG-compliant treatments for breast-conserving therapy, chemotherapy, endocrine therapy, and radiotherapy.…”

Section: Impact On Patient Outcomes Overall Survivalmentioning

confidence: 99%

“…Although non-adherence was associated with lower survival rate both in triple negative breast cancer (TNBC) and non-TNBC patients, this association was stronger in TNBC than in non-TBNC patients [19,43]. Seven studies explored adherence by treatment modality [18,19,30,37,43,47,48], revealing that there was better overall survival in patients receiving CG-compliant treatments for breast-conserving therapy, chemotherapy, endocrine therapy, and radiotherapy. One before after study did not find significant differences in survival rates comparing adherent versus non-adherent groups [21].…”

Section: Impact On Patient Outcomes Overall Survivalmentioning

confidence: 99%

“…Some studies have shown that CGs adherence can have a positive impact on patient outcomes in the field of breast cancer [17][18][19][20]. On the other hand, some authors have suggested a paradox by which guideline deviations would contribute to increased survival of patients with breast cancer (proposing that observed improvements in health outcomes during the last two decades may be more due to higher resource availability rather than adherence to guidelines) [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries

Ricci‐Cabello

Vásquez-Mejía

Canelo‐Aybar

et al. 2020

BMC Health Serv Res

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Background Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of BC guideline adherence -as prognosis factor- on BC healthcare processes and health outcomes. The objectives are to analyse the impact of guideline adherence on health outcomes and on healthcare costs. Methods We searched systematic reviews and primary studies in MEDLINE and Embase, conducted in European Union (EU) countries (inception to May 2019). Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second. We used random-effects meta-analyses to examine the impact of guideline adherence on overall survival and disease-free survival, and assessed certainty of evidence using GRADE. Results We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on treatment guideline adherence (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR = 0.67, 95%CI 0.59–0.76) and disease-free survival (HR = 0.35, 95%CI 0.15–0.82), representing 138 more survivors (96 more to 178 more) and 336 patients free of recurrence (73 more to 491 more) for every 1000 women receiving adherent CG treatment compared to those receiving non-adherent treatment at 5 years follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty). Conclusions Our review of EU studies suggests that there is moderate certainty that adherence to BC guidelines is associated with an improved survival. BC guidelines should be rigorously implemented in the clinical setting. Trial registration PROSPERO (CRD42018092884).

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“…The incidence of breast cancer is directly proportional to aging, and approximately 40–50% of women diagnosed with breast cancer are older than 65 years [ 2 , 3 ]. Breast cancer in elderly patients often presents with distinctive biological characteristics including absence of p53 mutations, presence of hormone receptors, luminal molecular subtype, and low proliferative indices [ 4 , 5 ]. Furthermore, elderly patients with breast cancer are more likely to present with more advanced tumors, and the risk for lymph node metastasis increases with age [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Association between obesity and trastuzumab-related cardiac toxicity in elderly patients with breast cancer

Wang

Yin

Jia³

et al. 2017

Oncotarget

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PurposeTrastuzumab can improve the prognosis for patients with breast cancer, but its related cardiac toxicity is concerning. This study aimed to identify the risk factors associated with trastuzumab-related cardiac toxicity in elderly patients with HER2-positive breast cancer.Patients and methodsA total of 133 elderly (≥ 65 years) patients who were diagnosed with breast cancer between June 1, 2007, and January 31, 2016, and received trastuzumab treatment were retrospectively reviewed. Cardiac events were defined as: (1) LVEF reduction of >10% from baseline echocardiography, (2) reduction of LVEF to <50%, and (3) signs and symptoms of heart failure as defined by the Common Terminology Criteria for Adverse Events (CTCAE) accompanied by a decrease in the LVEF. Univariate and multivariate regression analyses were used to determine the contribution of different clinical variables to trastuzumab-related cardiac events.ResultsThe median age of the cohort was 71.0 years (range, 65–81 years). The median follow-up period for measurement of left ventricular ejection fraction was 11.0 months (range, 2–71 months). Fifteen patients (11.2%) experienced cardiac events during the follow-up. Multivariate regression analysis revealed that obesity (odd ratio[OR], 4.706; 95% CI, 1.984-10.147; P = 0.002) was a statistically significant risk factor associated with cardiac events.ConclusionObesity is an independent risk factor for trastuzumab-related cardiac toxicity in elderly patients with breast cancer, receiving trastuzumab. Further studies are needed to establish the independent predictive value of obesity on cardiotoxicity in these patients.

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Tumor biology in older breast cancer patients – What is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients

Cited by 12 publications

References 42 publications

Treatment Quality in Breast Cancer

Treatment Quality in Breast Cancer

Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries

Association between obesity and trastuzumab-related cardiac toxicity in elderly patients with breast cancer

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