Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: Assessing outcome in a population-based, observational cohort Journal Article
| Authors: | Elkin, E. B.; Hurria, A.; Mitra, N.; Schrag, D.; Panageas, K. S. |
| Article Title: | Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: Assessing outcome in a population-based, observational cohort |
| Abstract: | Purpose: For older breast cancer patients, there is limited evidence of the efficacy of adjuvant chemotherapy from randomized clinical trials. Our goal was to assess the relationship between adjuvant chemotherapy use and survival in a large, population-based cohort of older women with hormone receptor (HR) -negative breast cancer. Methods: We identified women age 66 and older diagnosed with HR-negative, nonmetastatic breast cancer from 1992 to 1999 in the Surveillance, Epidemiology and End Results (SEER) cancer registries. Chemotherapy use was identified in Medicare claims linked to SEER records. Clinical and sociodemographic predictors of chemotherapy use were identified using logistic regression. The effect of chemotherapy on survival was evaluated using propensity score methods and multivariable proportional hazards regression. Results: A total of 1,711 (34%) of 5,081 women with HR-negative breast cancer received chemotherapy within 6 months of cancer diagnosis. Chemotherapy use decreased with increasing age and comorbidity, and increased with year of diagnosis, tumor size, number of positive lymph nodes, and higher tumor grade. Adjuvant chemotherapy was associated with a mortality reduction of approximately 15% whether analyzed using propensity scores or standard multivariate methods. The greatest overall survival benefit was observed in patients with node-positive disease and in the node-negative patients most likely to receive chemotherapy. Conclusion: This analysis suggests a survival benefit from adjuvant chemotherapy in older women with HR-negative breast cancer. The benefit of chemotherapy is most pronounced in the patients most likely to be selected for treatment, including those with involved lymph nodes or other high-risk disease characteristics. © 2006 by American Society of Clinical Oncology. |
| Keywords: | survival; cancer survival; controlled study; aged; aged, 80 and over; survival analysis; major clinical study; mortality; cancer adjuvant therapy; chemotherapy, adjuvant; outcome assessment; lymph node metastasis; antineoplastic agent; lymphatic metastasis; cancer grading; cohort studies; breast cancer; proportional hazards models; cohort analysis; pathology; breast neoplasms; patient identification; medicare; correlation analysis; proportional hazards model; adjuvant chemotherapy; breast tumor; lymph node; cancer size; comorbidity; scoring system; cancer registry; seer program; receptors, estrogen; receptors, progesterone; estrogen receptor; progesterone receptor; observational study; logistic regression analysis; socioeconomics; drug use; population based case control study |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 24 |
| Issue: | 18 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2006-06-20 |
| Start Page: | 2757 |
| End Page: | 2764 |
| Language: | English |
| DOI: | 10.1200/jco.2005.03.6053 |
| PUBMED: | 16782916 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 79" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus" |
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