Abstract
Abstract
Introduction
Lack of surgery for older breast cancer patients may reduce cancer survival. Previous studies did not adjust for comorbidity and tumour characteristics which affect survival.
Methods
In a prospective cohort study investigating older patients' treatment, survival analyses (mean 3.8 years, 95% CI: 3.69-3.83) was undertaken for 910 breast cancer patients aged ≥65 years diagnosed at 22 English hospitals from 1/7/10 to 31/12/12. Primary outcome was breast cancer specific survival. Independent variables included surgery, comorbidity, functional status and tumour characteristics recorded from patient interview (at diagnosis) and case note review. Data analyses included Cox's multiple regression.
Results
Adjusting for tumour stage, comorbidity and functional status, women undergoing primary surgery (n=772) had a third of the hazard of breast cancer death compared to those who did not (n=138) (HR 0.36, 95% CI: 0.20-0.66, p=0.001). The number of observed breast cancer deaths exceeded those expected for participants who did not have primary surgery, were aged ≥85 years, steroid receptor negative or had a higher grade or stage tumour. In univariate analysis women aged ≥85 years had an increased hazard of breast cancer death compared to 65-69 year olds (HR 4.02, 95% CI: 1.61-10.01, p=0.003). Patients' role in the treatment decisions did not alter whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive (i.e. left the decision up to the Surgeon).
Conclusions
Surgery for older breast cancer patients reduces the hazard of cancer death by a third, independent of age, comorbidity and tumour characteristics. Surgeons must actively advise surgery for all elderly patients.
Introduction
Lack of surgery for older breast cancer patients may reduce cancer survival. Previous studies did not adjust for comorbidity and tumour characteristics which affect survival.
Methods
In a prospective cohort study investigating older patients' treatment, survival analyses (mean 3.8 years, 95% CI: 3.69-3.83) was undertaken for 910 breast cancer patients aged ≥65 years diagnosed at 22 English hospitals from 1/7/10 to 31/12/12. Primary outcome was breast cancer specific survival. Independent variables included surgery, comorbidity, functional status and tumour characteristics recorded from patient interview (at diagnosis) and case note review. Data analyses included Cox's multiple regression.
Results
Adjusting for tumour stage, comorbidity and functional status, women undergoing primary surgery (n=772) had a third of the hazard of breast cancer death compared to those who did not (n=138) (HR 0.36, 95% CI: 0.20-0.66, p=0.001). The number of observed breast cancer deaths exceeded those expected for participants who did not have primary surgery, were aged ≥85 years, steroid receptor negative or had a higher grade or stage tumour. In univariate analysis women aged ≥85 years had an increased hazard of breast cancer death compared to 65-69 year olds (HR 4.02, 95% CI: 1.61-10.01, p=0.003). Patients' role in the treatment decisions did not alter whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive (i.e. left the decision up to the Surgeon).
Conclusions
Surgery for older breast cancer patients reduces the hazard of cancer death by a third, independent of age, comorbidity and tumour characteristics. Surgeons must actively advise surgery for all elderly patients.
| Original language | English |
|---|---|
| Title of host publication | Cancer Res |
| Publisher | American Association for Cancer Research |
| Pages | P3-13-02 |
| Number of pages | 1 |
| Volume | 77 |
| Edition | (4 suppl) |
| Publication status | Published - 1 Feb 2017 |
