Use and outcomes of adjuvant chemotherapy in older women with breast cancer
Abstract
Purpose: This study was undertaken to determine patterns and outcomes of adjuvant chemotherapy use in a population-based cohort of older women with primary breast cancer. Patients and Methods: Women were identified from the Surveillance, Epidemiology, and End Results–Medicare-linked database who met the following criteria: age ≥ 65 years, stage I to III breast cancer, and diagnosis between 1991 and 1999. Adjuvant chemotherapy use was ascertained by Common Procedural Terminology J codes. Logistic regression analysis was performed to determine factors associated with chemotherapy use. Multivariate Cox proportional hazards models were used to calculate the hazard of death for women with and without chemotherapy. Results: A total of 41,390 women met study criteria, of whom 4,500 (10.9%) received chemotherapy. The use of adjuvant chemotherapy more than doubled during the 1990s, from 7.4% in 1991 to 16.3% in 1999 (P < .0001), with a significant shift toward anthracycline use. Women who were younger, white, with lower comorbidity scores, more advanced stage disease, and estrogen receptor (ER) –negative disease were significantly more likely to receive chemotherapy. Chemotherapy was not associated with improved survival among women with lymph node–negative (LN) disease or LN-positive, ER-positive disease (hazard ratio [HR], 1.05; 95% CI, 0.85 to 1.31). However, among women with LN-positive, ER-negative breast cancer, chemotherapy was associated with a significant reduction in breast cancer mortality (HR, 0.72; 95% CI, 0.54 to 0.96). A similar significant benefit of chemotherapy was seen in the subset of women age 70 years or older (HR, 0.74; 95% CI, 0.56 to 0.97). Conclusion: In this observational cohort, chemotherapy was associated with a significant reduction in mortality among older women with ER-negative, LN-positive breast cancer.
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A pooled analysis of two trials found that SBRT yielded superior 3-year overall survival compared with surgery.
“Combined data from two trials comparing SBRT with surgery showed better 3-year overall survival for SBRT and no differences in locoregional and distant recurrence, although this analysis should be interpreted with caution in view of the small number of patients enrolled [72].”
The same pooled analysis of two trials found no differences between SBRT and surgery in locoregional or distant recurrence.
“Combined data from two trials comparing SBRT with surgery showed better 3-year overall survival for SBRT and no differences in locoregional and distant recurrence, although this analysis should be interpreted with caution in view of the small number of patients enrolled [72].”
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- Authors
- Giordano, S. H., Duan, Z., Kuo, Y.-F., Hortobagyi, G. N., & Goodwin, J. S.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- From the Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston; and the Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX
- Venue
- Journal of Clinical Oncology
- Published
- 2006-06-20
- Volume
- 24
- Issue
- 18
- Pages
- 2750-2756
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2145545573
- Cited by
- 318
- References
- 26
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 4 · 2023: 8 · 2022: 16 · 2021: 17 · 2020: 18 · 2019: 16 · 2018: 7 · 2017: 14 · 2016: 14 · 2015: 17 · 2014: 9 · 2013: 20 · 2012: 13
- FWCI
- 9.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p50ca105631-05)
- National Cancer Institute (K07CA109064, P50-CA105631)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- adjuvant chemotherapy, older women, breast cancer, chemotherapy use, anthracyclines, estrogen receptor-negative breast cancer, node-positive breast cancer, breast cancer mortality, comorbidities, treatment patterns
- MeSH terms
- Aged, Breast Neoplasms, Female, Humans, Lymphatic Metastasis, Proportional Hazards Models, Survival Analysis, Chemotherapy, Adjuvant, SEER Program
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