Is the lack of surgery amongst older postmenopausal women with breast cancer explained by comorbidity

Steven Oliver; Katrina Lavelle; Amy Downing; James Thomas; Gill Lawrence; David Forman

Is the lack of surgery amongst older postmenopausal women with breast cancer explained by comorbidity

Steven Oliver, Katrina Lavelle, Amy Downing, James Thomas, Gill Lawrence, David Forman

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

Abstract

ObjectivesAudit data consistently report around 60% of UK women aged ≥80 years old do not have surgery fortheir breast cancer (compared with <10% of younger women). However, previous studies have notadjusted for patient co-morbidity. We have therefore investigated the extent to which age-associateddifferences in breast cancer surgery rates, amongst women aged ≥65 years, can be accounted for byco-morbidity.MethodsWomen with invasive breast cancer diagnosed between 1997- 2005 in the Northern & Yorkshire andWest Midlands regions were identified from cancer registration, along with whether surgery wasreceived. Linkage to Hospital Episode Statistics (HES) was used to estimate co-morbidity in thepreceding year. The Charlson co-morbidity score (range 0 [no co-morbidity] to 6 [greatest comorbidity])was derived from clinical coding within HES. In addition to co-morbidity, the impact oftumour stage, deprivation, year and region on treatment received were also examined.ResultsRecords were available for 23,038 women aged ≥65 years. The proportion receiving surgery fell in thepresence of increasing co-morbidity (Charlson score 0= 74%, score 1= 66%, score 2= 52%, score3+=43%) However, after adjustment for co-morbidity and other covariates, older age continued topredict lack of surgery. Compared to 65-69 year olds, the odds of surgery decreased with age from0.74 (95% CI: 0.66-0.83) for 70-74 year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥85 years.The proportion of women receiving surgery was significantly lower in more deprived areas, butincreased with each successive diagnosis year group.ConclusionsWhilst co-morbidity, as measured in administrative data, is associated with a reduced likelihood ofsurgery, it does not explain the apparent shortfall in surgery amongst older women in the UK. Futureresearch should consider the importance of patient preferences for treatment in addition toindividual-level measures of co-morbidity and frailty.

Original language	English
Title of host publication	host publication
Publication status	Published - Jun 2011
Event	National Cancer Intelligence Network: Liberating Information and improving outcomes - London Duration: 15 Jun 2011 → 17 Jun 2011 http://www.ncin.org.uk/view.aspx?rid=661

Conference

Conference	National Cancer Intelligence Network: Liberating Information and improving outcomes
City	London
Period	15/06/11 → 17/06/11
Internet address	http://www.ncin.org.uk/view.aspx?rid=661

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

Cite this

@inproceedings{276b034c5b014e1e844a3a3117eada88,

title = "Is the lack of surgery amongst older postmenopausal women with breast cancer explained by comorbidity",

abstract = "ObjectivesAudit data consistently report around 60% of UK women aged ≥80 years old do not have surgery fortheir breast cancer (compared with <10% of younger women). However, previous studies have notadjusted for patient co-morbidity. We have therefore investigated the extent to which age-associateddifferences in breast cancer surgery rates, amongst women aged ≥65 years, can be accounted for byco-morbidity.MethodsWomen with invasive breast cancer diagnosed between 1997- 2005 in the Northern & Yorkshire andWest Midlands regions were identified from cancer registration, along with whether surgery wasreceived. Linkage to Hospital Episode Statistics (HES) was used to estimate co-morbidity in thepreceding year. The Charlson co-morbidity score (range 0 [no co-morbidity] to 6 [greatest comorbidity])was derived from clinical coding within HES. In addition to co-morbidity, the impact oftumour stage, deprivation, year and region on treatment received were also examined.ResultsRecords were available for 23,038 women aged ≥65 years. The proportion receiving surgery fell in thepresence of increasing co-morbidity (Charlson score 0= 74%, score 1= 66%, score 2= 52%, score3+=43%) However, after adjustment for co-morbidity and other covariates, older age continued topredict lack of surgery. Compared to 65-69 year olds, the odds of surgery decreased with age from0.74 (95% CI: 0.66-0.83) for 70-74 year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥85 years.The proportion of women receiving surgery was significantly lower in more deprived areas, butincreased with each successive diagnosis year group.ConclusionsWhilst co-morbidity, as measured in administrative data, is associated with a reduced likelihood ofsurgery, it does not explain the apparent shortfall in surgery amongst older women in the UK. Futureresearch should consider the importance of patient preferences for treatment in addition toindividual-level measures of co-morbidity and frailty.",

author = "Steven Oliver and Katrina Lavelle and Amy Downing and James Thomas and Gill Lawrence and David Forman",

year = "2011",

month = jun,

language = "English",

booktitle = "host publication",

note = "National Cancer Intelligence Network: Liberating Information and improving outcomes ; Conference date: 15-06-2011 Through 17-06-2011",

url = "http://www.ncin.org.uk/view.aspx?rid=661",

}

TY - GEN

T1 - Is the lack of surgery amongst older postmenopausal women with breast cancer explained by comorbidity

AU - Oliver, Steven

AU - Lavelle, Katrina

AU - Downing, Amy

AU - Thomas, James

AU - Lawrence, Gill

AU - Forman, David

PY - 2011/6

Y1 - 2011/6

N2 - ObjectivesAudit data consistently report around 60% of UK women aged ≥80 years old do not have surgery fortheir breast cancer (compared with <10% of younger women). However, previous studies have notadjusted for patient co-morbidity. We have therefore investigated the extent to which age-associateddifferences in breast cancer surgery rates, amongst women aged ≥65 years, can be accounted for byco-morbidity.MethodsWomen with invasive breast cancer diagnosed between 1997- 2005 in the Northern & Yorkshire andWest Midlands regions were identified from cancer registration, along with whether surgery wasreceived. Linkage to Hospital Episode Statistics (HES) was used to estimate co-morbidity in thepreceding year. The Charlson co-morbidity score (range 0 [no co-morbidity] to 6 [greatest comorbidity])was derived from clinical coding within HES. In addition to co-morbidity, the impact oftumour stage, deprivation, year and region on treatment received were also examined.ResultsRecords were available for 23,038 women aged ≥65 years. The proportion receiving surgery fell in thepresence of increasing co-morbidity (Charlson score 0= 74%, score 1= 66%, score 2= 52%, score3+=43%) However, after adjustment for co-morbidity and other covariates, older age continued topredict lack of surgery. Compared to 65-69 year olds, the odds of surgery decreased with age from0.74 (95% CI: 0.66-0.83) for 70-74 year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥85 years.The proportion of women receiving surgery was significantly lower in more deprived areas, butincreased with each successive diagnosis year group.ConclusionsWhilst co-morbidity, as measured in administrative data, is associated with a reduced likelihood ofsurgery, it does not explain the apparent shortfall in surgery amongst older women in the UK. Futureresearch should consider the importance of patient preferences for treatment in addition toindividual-level measures of co-morbidity and frailty.

AB - ObjectivesAudit data consistently report around 60% of UK women aged ≥80 years old do not have surgery fortheir breast cancer (compared with <10% of younger women). However, previous studies have notadjusted for patient co-morbidity. We have therefore investigated the extent to which age-associateddifferences in breast cancer surgery rates, amongst women aged ≥65 years, can be accounted for byco-morbidity.MethodsWomen with invasive breast cancer diagnosed between 1997- 2005 in the Northern & Yorkshire andWest Midlands regions were identified from cancer registration, along with whether surgery wasreceived. Linkage to Hospital Episode Statistics (HES) was used to estimate co-morbidity in thepreceding year. The Charlson co-morbidity score (range 0 [no co-morbidity] to 6 [greatest comorbidity])was derived from clinical coding within HES. In addition to co-morbidity, the impact oftumour stage, deprivation, year and region on treatment received were also examined.ResultsRecords were available for 23,038 women aged ≥65 years. The proportion receiving surgery fell in thepresence of increasing co-morbidity (Charlson score 0= 74%, score 1= 66%, score 2= 52%, score3+=43%) However, after adjustment for co-morbidity and other covariates, older age continued topredict lack of surgery. Compared to 65-69 year olds, the odds of surgery decreased with age from0.74 (95% CI: 0.66-0.83) for 70-74 year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥85 years.The proportion of women receiving surgery was significantly lower in more deprived areas, butincreased with each successive diagnosis year group.ConclusionsWhilst co-morbidity, as measured in administrative data, is associated with a reduced likelihood ofsurgery, it does not explain the apparent shortfall in surgery amongst older women in the UK. Futureresearch should consider the importance of patient preferences for treatment in addition toindividual-level measures of co-morbidity and frailty.

M3 - Conference contribution

BT - host publication

T2 - National Cancer Intelligence Network: Liberating Information and improving outcomes

Y2 - 15 June 2011 through 17 June 2011

ER -

Is the lack of surgery amongst older postmenopausal women with breast cancer explained by comorbidity

Abstract

Conference

UN SDGs

Access to Document

Fingerprint

Cite this