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Pattern of care and survival in older women with breast cancer in India

Published online by Cambridge University Press:  23 November 2010

Budhi S. Yadav ,
Suresh C. Sharma ,
G. Menu ,
A. Mohmad ,
Firuza D. Patel ,
K. Nisar  and
G. Sushmita
Budhi S. Yadav
Affiliation:
Pinnacle Cancer Care Centre, Ivy Hospital, Sector-71, Mohali, India
Suresh C. Sharma
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
G. Menu
Affiliation:
Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India
A. Mohmad
Affiliation:
Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India
Firuza D. Patel
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
K. Nisar
Affiliation:
Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India
G. Sushmita
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Purpose: To determine the pattern of care and survival in older patients with breast cancer.

Methods: The study population included 228 women aged ≥60 years with breast cancer treated between 1992 and 2002. Analysis was done for surgery, radiotherapy (RT), chemotherapy and hormonal therapy. Outcomes studied were locoregional recurrence (LRR) distant metastases, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. Kaplan–Meier method was used to estimate DFS and OS.

Results: Mastectomy was done in 208 (91%) patients and conservative breast surgery (CBS) only in 20 (9%) patients. Majority of the patients received adjuvant RT 179 (78.5%). Chemotherapy was given to 49 (21.5%) patients and hormones to 204 (89.5%) patients. LRR with or without distant metastases was 7% and distant metastasis rate was 19.3%. DFS at 10 years was 69%. With RT, DFS was 76% in patients aged <65 years and 73% in aged ≥65 years (p = 0.13). It was 73 and 86%, respectively, with chemotherapy (p = 0.041). DFS with hormones was 96% in patients aged ≥65 years and 79% in aged <65 years (p = 0.028). The OS was 74% at 10 years. RT improved OS in all patients. OS with chemotherapy was 94% in patients ≥65 years, and 82% in patients <65 years (p = 0.044). With hormonal therapy OS was 96% in patients aged ≥65 years and 78% in patients <65 years (p = 0.020).

Conclusion: CBS rate and chemotherapy use is very low in elderly women with breast cancer in India. Adjuvant RT, chemotherapy and hormonal therapy offered a therapeutic advantage in these patients.

Keywords

Breast cancerChemotherapyHormonesRadiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 9 , Issue 4 , December 2010 , pp. 237 - 245
Copyright
Copyright © Cambridge University Press 2010

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References

Greenlee, RT, Hill-Harmon, MB, Murray, T et al. Cancer Statistics, 2001. CA Cancer J Clin 2001; 51: 15–36.CrossRefGoogle ScholarPubMed
Yancik, R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997; 80: 1273–1283.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Registrar General of India SRS Based Abridged Life Tables, SRS Analytical Studies, Report No. 3 of 2003. Registrar General of India: New Delhi.Google Scholar
Hutchins, LF, Unger, JM, Crowley, JJ et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials, N Engl J Med 2000; 341: 2061–2067.Google Scholar
Mitka, M. Too few older patients in cancer trials. JAMA 2003; 27: 27–28.Google Scholar
Du, XL, Goodwin, JS. Patterns of use of chemotherapy for breast cancer in older women: findings from Medicare claims data. J Clin Oncol 2001; 19: 1455–1461.CrossRefGoogle ScholarPubMed
Townsley, CA, Selby, R, Siu, LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 2005; 23: 3112–3124.CrossRefGoogle Scholar
Diab, SG, Elledge, RM, Clark, GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 2000; 92: 550–556.Google Scholar
Wyld, L, Reed, MW. The need for targeted research into breast cancer in the elderly. Br J Surg 2003; 90: 388–399.Google Scholar
Vicini, FA, Recht, A. Age at diagnosis and outcome for women with ductal carcinoma-in-situ of the breast: a critical review of the literature. J Clin Oncol 2002; 20: 2736–2744.Google Scholar
Jobsen, JJ, van der Palen, J, Meerwaldt, JH. The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy. Eur J Cancer 2001; 37: 1820–1827.Google Scholar
Gennari, R, Curigliano, G, Rotmensz, N et al. Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer 2004; 101: 1302–1310.CrossRefGoogle Scholar
Hughes, KS, Schnaper, LA, Berry, D et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer, N Engl J Med 2004; 351: 971–977.CrossRefGoogle ScholarPubMed
Bouchardy, C, Rapiti, E, Gerald, F et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 2003; 21: 3580–3587.CrossRefGoogle ScholarPubMed
Greenfield, S, Blanco, DM, Elashoff, RM et al. Patterns of care related to age of breast cancer patients. JAMA 1987; 257: 2766–2770.Google Scholar
Buchholz, TA, Theriault, TA, Theriault, RL et al. The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network centers. J Clin Oncol 2006; 24: 361–369.CrossRefGoogle ScholarPubMed
Giordano, SH, Duan, Z, Kuo, YF et al. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 2006; 24: 2750–2756.CrossRefGoogle ScholarPubMed
Chagpor, AB, Studts, JL, Scoggins, CR et al. Factors associated with surgical options for breast carcinoma. Cancer 2006; 106: 1462–1466.CrossRefGoogle Scholar
Goel, MS, Burns, RB, Phillips, RS et al. Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992–2000. J Gen Intern Med 2005; 20: 604–611.Google Scholar
Hiotis, K, Ye, W, Sposto, R et al. Predictors of breast conservation therapy. Cancer 2005; 103: 892–899.CrossRefGoogle ScholarPubMed
Fink, AK, Gurwitz, J, Rakowski, W et al. Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor—positive breast cancer, J Clin Oncol 2004; 22: 3309–3315.CrossRefGoogle ScholarPubMed
Enger, SM, Thwin, SS, Buist, DSM et al. Breast cancer treatment of older women in integrated health care settings. J Clin Oncol 2006; 24: 4377–4383.CrossRefGoogle ScholarPubMed
DeMichele, A, Putt, M, Zhang, Y et al. Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients, Cancer 2003; 97: 2150–2159.Google Scholar
Clarke, M, Collins, R, Darby, S et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and on 15-year survival: an overview of the randomised trials. Lancet 2005; 366: 2087–2106.Google Scholar
Glick, JH, Gelber, RD, Goldhirsch, A et al. Meeting highlights: adjuvant therapy for primary breast cancer, J Natl Cancer Inst 1992; 84: 1479–1485.CrossRefGoogle ScholarPubMed
Goldhirsch, A, Glick, JH, Gelber, RD et al. International Consensus Panel on the Treatment of Primary Breast Cancer: V. Update 1998. Recent Results Cancer Res 1998; 152: 481–497.Google Scholar
National Institutes of Health Consensus Development Conference statement: Adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst Monogr 2001: 5–15.Google Scholar
Yancik, R, Wesley, MN, Ries, LA et al. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 2001; 285: 885–892.Google Scholar
Polychemotherapy for early breast cancer: an overview of the randomised trials—Early Breast Cancer Trialists' Collaborative Group. Lancet 1998; 352: 930–942.CrossRefGoogle Scholar
Extermann, M, Balducci, L, Lyman, GH. What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 2000; 18: 1709–1717.CrossRefGoogle ScholarPubMed
Giordano, SH, Hortobagyi, GN, Kau, SC et al. Breast cancer treatment guidelines in older women, J Clin Oncol 2005; 23: 783–791.CrossRefGoogle ScholarPubMed
Mandelblatt, JS, Hadley, J, Kerner, JF et al. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences, Cancer 2000; 89: 61–573.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Smith, BD, Haffty, BG, Hurria, A et al. Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol 2006; 24: 4901–4907.Google Scholar
Du, X, Freeman, JL, Goodwin, JS. Information on radiation treatment in patients with breast cancer: the advantages of the linked medicare and SEER data—Surveillance, Epidemiology and End Results. J Clin Epidemiol 1999; 52: 463–470.Google Scholar
Fyles, AW, McCready, DR, Manchul, LA et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 2004; 351: 963–970.Google Scholar
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15 year survival: an overview of randomized trials. Lancet 2005; 365: 1687–1717.Google Scholar
Geiger, AM, Thwin, SS, Buist, DSM et al. Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer 2007; 109: 966–974.Google Scholar
Yadav, BS, Sharma, SC, Patel, FD, Ghoshal, S, Kapoor, RK. Second primary in the contralateral breast after treatment of breast cancer. Radiother Oncol 2008; 86: 171–176.Google Scholar
Love, RR, Mazess, RB, Barden, HS et al. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med 1992; 326: 852–856.Google Scholar
Reis, SE, Costantino, JP, Wickerham, DL et al. Cardiovascular effects of tamoxifen in women with and without heart disease: Breast Cancer Prevention Trial. J Natl Cancer Inst 2001; 93: 16–21.CrossRefGoogle ScholarPubMed
Nordenskjold, B, Rosell, J, Rutqvist, L-E et al. Coronary heart disease mortality after 5 years of adjuvant tamoxifen therapy: results from a randomized trial. J Natl Cancer Inst 2005; 97: 1609–1610.CrossRefGoogle ScholarPubMed
Rutqvist, LE, Mattsson, A. Cardiac and thromboembolic morbidity among postmenopausal women with early-stage breast cancer in a randomized trial of adjuvant tamoxifen. J Natl Cancer Inst 1993; 85: 1398–1406.Google Scholar
Silliman, RA, Guadagnoli, E, Rakowski, W et al. Adjuvant tamoxifen prescription in women 65 years and older with primary breast cancer. J Clin Oncol 2002; 20: 2680–2688.CrossRefGoogle ScholarPubMed