Impact of endocrine therapy adherence on outcomes in elderly women with early-stage breast cancer undergoing lumpectomy without radiotherapy Journal Article

   

Authors:	Matar, R.; Sevilimedu, V.; Gemignani, M. L.; Morrow, M.
Article Title:	Impact of endocrine therapy adherence on outcomes in elderly women with early-stage breast cancer undergoing lumpectomy without radiotherapy
Abstract:	Background: National Comprehensive Center Network guidelines recommend radiotherapy (RT) omission in women age ≥ 70 years with estrogen receptor-positive (ER+), cN0, T1 tumors post-lumpectomy if they receive endocrine therapy (ET). However, little is known about the impact of poor adherence on locoregional recurrence (LRR) in elderly women forgoing RT. Methods: Women age ≥ 70 years with pT1–2 ER+ breast cancer undergoing lumpectomy without RT from 2004 to 2019 were identified from a prospectively maintained database. ET adherence, calculated as treatment duration over follow-up time up to 5 years, was determined by chart review. We compared clinicopathologic characteristics and rates of LRR between women with high adherence (≥ 80%), low adherence (< 80%), and no ET. Results: Of 968 women (27 bilateral cancers), adherence was high in 676 (70%) and low in 162 (17%); 130 (13%) took no ET. Younger age and use of aromatase inhibitor were associated with high adherence. On multivariable analysis, tumor size (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03–2.68, p = 0.04) and high adherence (HR 0.13, 95% CI 0.07–0.26, p < 0.001) were significantly associated with LRR. At 53 months median follow-up, the 5-year rate of LRR was 3.1% (95% CI 2.4–3.9%) with high adherence, 14.7% (95% CI 11.7–17.7%) with low adherence, and 17.9% (95% CI 13.9–21.8%) with no ET (p < 0.01). Conclusions: Although adherence to ET was high overall, in the 30% of women with low adherence or no ET, LRR rates were significantly increased. Counseling regarding the distinct toxicities of ET and RT can help patients choose the therapy to which they will likely adhere to. © 2022, Society of Surgical Oncology.
Keywords:	cancer survival; controlled study; treatment outcome; aged; cancer surgery; major clinical study; cancer recurrence; treatment duration; radiotherapy, adjuvant; cancer staging; recurrence risk; follow up; neoplasm staging; prospective study; neoplasm recurrence, local; aromatase inhibitor; pathology; breast neoplasms; medical record review; tumor recurrence; breast tumor; cancer size; partial mastectomy; tamoxifen; hormonal therapy; adjuvant radiotherapy; mastectomy, segmental; histogram; lumpectomy; adverse event; medication compliance; estrogen receptor positive breast cancer; humans; human; female; article
Journal Title:	Annals of Surgical Oncology
Volume:	29
Issue:	8
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2022-08-01
Start Page:	4753
End Page:	4760
Language:	English
DOI:	10.1245/s10434-022-11728-5
PUBMED:	35461424
PROVIDER:	scopus
PMCID:	PMC10208089
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85128759301&doi=10.1245%2fs10434-022-11728-5&partnerID=40&md5=60ce04e15b64cd98cfe4ef68172f94f1
Notes:	Article -- Export Date: 1 August 2022 -- Source: Scopus

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