TY - JOUR
T1 - Short-term mortality in older patients treated with adjuvant chemotherapy for early-stage breast cancer
AU - Rosenstock, Aron Salomon
AU - Lei, Xiudong
AU - Tripathy, Debu
AU - Hortobagyi, Gabriel N.
AU - Giordano, Sharon H.
AU - Chavez-MacGregor, Mariana
N1 - Funding Information:
This study was supported by the National Cancer Institute’s Cancer Center Support grant awarded to MD Anderson Cancer Center (Grant No. 2P30 CA016672) and the Duncan Family Institute. Mariana Chavez-MacGregor and Sharon H. Giordano are supported by the Center for Comparative Effectiveness Research on Cancer in Texas (CPRIT) (Grant No. PR140020-P2) and by Susan G. Komen Breast Cancer Foundation (Grant No. SAC150061).
Funding Information:
Participants from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER)/Texas Cancer Registry (TCR)–Medicare-linked databases were retrospectively analyzed. The SEER program is supported by the US National Cancer Institute (NCI) and collects data from tumor registries covering 28 % of the US population []. The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS) and covers 97 % of the US population age 65 or older []. SEER participants are matched with Medicare records under an agreement with the NCI and CMS. Of SEER participants who were diagnosed with cancer at age 65 years or older, 94 % are matched with their Medicare enrollment records.
Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Chemotherapy for early-stage breast cancer has lowered cancer recurrence and deaths. However, short-term mortality rates due to cancer or treatment in the general population remain largely unknown. In this study, we evaluate the short-term mortality rate and the determinants of such outcome among a cohort of older breast cancer patients treated with adjuvant chemotherapy. This is a population-based study based on the Surveillance, Epidemiology, and End Results Program (SEER)–Medicare and the Texas Cancer Registry (TCR)–Medicare databases. Patients diagnosed with early-stage breast cancer between 2003 and 2011 who were 66 years or older and were treated with adjuvant chemotherapy within 6 months of diagnosis were included. Short-term mortality was defined as death from any cause within one year of breast cancer diagnosis. Descriptive statistics and multivariable logistic regression modeling were used for the analysis. Of the 21,536 patients included, a total of 625 (2.9 %) died within one year of breast cancer diagnosis. In multivariate analysis, older age (using 66–70 as reference category; 71–75 years OR 1.31, 95 % CI 1.05–1.62; 76–80 years OR 1.73, 95 % CI 1.36–2.19; >80 years OR 3.48, 95 % CI 2.7–4.48) and higher comorbidity index (using Charlson score of 0 as a reference, those with score of 1 or >2 had higher risk OR 1.46, 95 % CI 1.19–1.8 and OR 2.98, 95 % CI 2.42–3.67, respectively) were associated with the increased risk of short-term mortality. Other factors significantly associated with the outcome were higher grade and stage, ER-negative status, poor census tract area, and mastectomy. The findings of this study revealed that, in this large cohort of older breast cancer patients treated with adjuvant chemotherapy, 2.9 % of the population died within one year of breast cancer diagnosis. Finally, it was concluded that tumor- and patient-related characteristics were associated with short-term death. Our findings add relevant information that can be used by clinicians when balancing the risk.
AB - Chemotherapy for early-stage breast cancer has lowered cancer recurrence and deaths. However, short-term mortality rates due to cancer or treatment in the general population remain largely unknown. In this study, we evaluate the short-term mortality rate and the determinants of such outcome among a cohort of older breast cancer patients treated with adjuvant chemotherapy. This is a population-based study based on the Surveillance, Epidemiology, and End Results Program (SEER)–Medicare and the Texas Cancer Registry (TCR)–Medicare databases. Patients diagnosed with early-stage breast cancer between 2003 and 2011 who were 66 years or older and were treated with adjuvant chemotherapy within 6 months of diagnosis were included. Short-term mortality was defined as death from any cause within one year of breast cancer diagnosis. Descriptive statistics and multivariable logistic regression modeling were used for the analysis. Of the 21,536 patients included, a total of 625 (2.9 %) died within one year of breast cancer diagnosis. In multivariate analysis, older age (using 66–70 as reference category; 71–75 years OR 1.31, 95 % CI 1.05–1.62; 76–80 years OR 1.73, 95 % CI 1.36–2.19; >80 years OR 3.48, 95 % CI 2.7–4.48) and higher comorbidity index (using Charlson score of 0 as a reference, those with score of 1 or >2 had higher risk OR 1.46, 95 % CI 1.19–1.8 and OR 2.98, 95 % CI 2.42–3.67, respectively) were associated with the increased risk of short-term mortality. Other factors significantly associated with the outcome were higher grade and stage, ER-negative status, poor census tract area, and mastectomy. The findings of this study revealed that, in this large cohort of older breast cancer patients treated with adjuvant chemotherapy, 2.9 % of the population died within one year of breast cancer diagnosis. Finally, it was concluded that tumor- and patient-related characteristics were associated with short-term death. Our findings add relevant information that can be used by clinicians when balancing the risk.
KW - Breast cancer
KW - Chemotherapy
KW - Elderly
KW - Mortality
KW - SEER
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UR - http://www.scopus.com/inward/citedby.url?scp=84965014191&partnerID=8YFLogxK
U2 - 10.1007/s10549-016-3815-y
DO - 10.1007/s10549-016-3815-y
M3 - Article
C2 - 27146586
AN - SCOPUS:84965014191
SN - 0167-6806
VL - 157
SP - 339
EP - 350
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 2
ER -