Impact of Comorbidities and Age on Cause-Specific Mortality in Postmenopausal Patients with Breast Cancer

The oncologist

article

Marloes G.M. Derks¹  Gerrit-Jan Liefers¹  Cornelis J.H. van de Velde¹  Daniele Giardiello²  Caroline Seynaeve⁴  Hein Putter²  Johan W.R. Nortier⁵  Luc Y. Dirix⁶  Esther Bastiaannet¹  Johanneke E.A. Portielje⁵ 

[1] Department of Surgery, Leiden University Medical Center;Department of Medical Statistics, Leiden University Medical Center;Department of Molecular Pathology, Netherlands Cancer Institute;Department of Medical Oncology, Erasmus MC Cancer Institute;Department of Medical Oncology, Leiden University Medical Center;Oncology Center

关键词: Geriatric oncology;    Breast cancer;    Aging;    Comorbidities;    Mortality;    Prediction;   

DOI  :  10.1634/theoncologist.2018-0010

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The aim was to study the impact of comorbidities and age on breast cancer mortality, taking into account competing causes of death. Subjects, Materials, and Methods Cohort analysis of Dutch and Belgian patients with postmenopausal, early hormone receptor-positive breast cancer included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. This is a randomized controlled trial of patients who had completed local treatment with curative intent and were randomized to receive exemestane for 5 years, or sequential treatment of tamoxifen followed by exemestane for a duration of 5 years. Patients were categorized by number of comorbidities (no comorbidities, 1–2 comorbidities, and >2 comorbidities) and age (2 comorbidities, p < .001). Conclusion Older patients without comorbidities have a higher risk of dying due to breast cancer than younger counterparts, even when taking into account higher competing mortality, while use of chemotherapy in this group was low. These findings underline the need to take into account comorbidities, age, and competing mortality in the prognosis of breast cancer for accurate decision making. Implications for Practice Older patients without comorbidity are at increased risk of dying from breast cancer, despite a higher other-cause mortality. This study shows that including age and comorbidity for the assessment of breast cancer mortality and other-cause mortality is indispensable for treatment decision making in older patients. Future prognostic tools for breast cancer prognosis should incorporate these items as well as risk of toxicity of adjuvant chemotherapy to adequately predict outcomes to optimize personalized treatment for older patients with early breast cancer.

【 授权许可】

CC BY|CC BY-NC