Volume 7, Issue 3, September 2019, Page: 51-61
The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer
Traci Le Masters, Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States; West Virginia University Cancer Institute, West Virginia University, Morgantown, United States
Suresh Madhavan, Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States; College of Pharmacy, University of North Texas, Dallas-Fort Worth, United States
Usha Sambamoorthi, Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States; West Virginia University Cancer Institute, West Virginia University, Morgantown, United States
Received: Aug. 20, 2019;       Accepted: Sep. 6, 2019;       Published: Oct. 11, 2019
DOI: 10.11648/j.jctr.20190703.12      View  139      Downloads  33
The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.
Breast Cancer, Guideline-concordant Care, Survival
To cite this article
Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi, The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer, Journal of Cancer Treatment and Research. Vol. 7, No. 3, 2019, pp. 51-61. doi: 10.11648/j.jctr.20190703.12
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Partridge AH, Hughes ME, Warner ET, Ottesen RA, Wong YN, Edge SB, et al. Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival. J Clin Oncol. 2016 Sep 20; 34 (27): 3308-14.
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30; 107 (6): djv048.
Freedman RA, Keating NL, Lin NU, Winer EP, Vaz-Luis Lii J, et al. Breast Cancer-Specific Survival by Age: Worse Outcomes for the Oldest Patients. Cancer. 2018 May 15; 124 (10): 2184-2191.
Derks MGM, Bastiaannet E, van de Water W, de Glas, Seynaeve C, Putter H, et al. Impact of age on breast cancer mortality and competing causes of death at 10 years follow-up in the adjuvant TEAM trial. Eur J Cancer. 2018 Aug; 99: 1-8.
National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Available at: https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site. Accessed August 7, 2017.
Reeder-Hayes K, Peacock Hinton S, Meng K, Carey LA, Dusetzina SB. Disparities in Use of Human Epidermal Growth Hormone Receptor 2-Targeted Therapy for Early-Stage Breast Cancer. J Clin Oncol. 2016; 10; 34 (17): 2003-2009.
LeMasters TJ, Madhavan SS, Sambamoorthi U, Vyas AM. Disparities in the Initial Local Treatment of Older Women with Early-Stage Breast Cancer: A Population-Based Study. J Womens Health (Larchmt). 2017; 26 (7): 735-744.
LeMasters T, Madhavan S, Sambamoorthi U, Hazard H, Kelly K, Long D. Receipt of Guideline-Concordant Care among Older Women with Stage I-III Breast Cancer: A Population-Based Study. J Natl Compr Canc Netw. 2018; 16 (6): 703-710.
Inwald EC, Ortmann O, Koller M, Zeman F, Hofstadter F, Evert M, et al. Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology. Breast Cancer Res Treat. 2017; 163 (1): 119-130.
Karavasilis V, Papadimitriou C2, Gogas H, Kouvatseas G, Pentheroudakis G, Koutras A, et al. Safety and Tolerability of Anthracycline-Containing Adjuvant Chemotherapy in Elderly High-Risk Breast Cancer Patients. Clin Breast Cancer. 2016; 16 (4): 291-298. e3.
Singh JC1, Lichtman SM. Effect of age on drug metabolism in women with breast cancer. Expert Opin Drug Metab Toxicol. 2015; 11 (5): 757-766.
Sun SX, Hollenbeak CS, Leung AM. Deviation from the Standard of Care for Early Breast Cancer in the Elderly: What are the Consequences? Ann Surg Oncol. 2015; 22 (8): 2492-2499.
Van de Water W, Bastiaannet E, Dekkers OM, de Craen AJ, Westendorp RG, Voogd AC, et al. Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis. Br J Surg. 2012; 99 (6): 813-820.
Kimmick GG, Li X, Fleming ST, Sabatino SA, Wilson JF, Lipscomb J, et al. Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer. J Geriatr Oncol. 2018; 9 (3): 214-220.
Berry SD, Ngo L, Samelson EJ, Kiel DP. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc. 2010 Apr; 58 (4): 783-787.
van de Water W, Markopoulos C, van de Velde CJ, Seynaeve C, Hasenburg A, Rea D, et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012; 307 (6): 579–597.
Engels EA, Pfeiffer RM, Ricker W, Wheeler W, Parsons R, Warren JL. Use of Surveillance, Epidemiology, and End Results-Medicare data to conduct case-control studies of cancer among the US elderly. Am J Epidemiol. 2011; 174: 860-870.
U.S. Health Resources and Services Administration, Bureau of Health Professions. Area Resource File, 2009-2010 Release Rockville, MD: U.S. Department of Health and Human Services. Fairfax, VA: Quality Resource Systems, Inc. Codebook: HE-001.
Howlader N, Ries LA, Mariotto AB, Reichman ME, Ruhl J, Cronin KA. Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst. 2010; 102: 1584-1598.
Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2009; 7 (2): 122-192.
Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL. The Association of Race/Ethnicity, Insurance Status, and Socioeconomic Factors with Breast Cancer Care. 2010; 117: 180-189.
Desch C, McNiff K, Schneider E, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol. 2008; 26 (21): 3631-3637.
Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions. Universal health outcome measures for older persons with multiple chronic conditions. J Am Geriatr Soc. 2012; 60: 2333–2341.
Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol 2000; 53 (12): 1258–67.
Fine, JP and Gray, RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. Journal of the American Statistical Association. 1999; 94: 496–509.
Eastell R, Adams J, Coleman R, Howell A, Hannon RA, Cuzick J, et al. Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol. 2008; 26 (7): 1051-1057.
Coates AS, Keshaviah A, Thürlimann B, Mouridsen H, Mauriac L, Forbes JF, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol. 2007; 25 (5): 486-92.
Wollschläger D, Meng X, Wöckel A, Janni W, Kreienberg R, Blettner M, et al. Comorbidity-dependent adherence to guidelines and survival in breast cancer-Is there a role for guideline adherence in comorbid breast cancer patients? A retrospective cohort study with 2137 patients. Breast J. 2018; 24 (2): 120-127.
Klepin HD, Pitcher BN, Ballman KV, Kornblith AB, Hurria A, Winer EP, et al. Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance). J Oncol Pract. 2014; 10 (5): e285-92.
Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, et al. Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival. J Natl Cancer Inst. 2017; 109 (9).
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