Abstract
Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80–2.83]), chemotherapy (1.25 [1.11–1.41]), radiotherapy (2.28 [1.94–2.69]) and endocrine therapy (1.70 [1.41–2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations.
Highlights
Breast cancer survival has improved with significant progress in treatment and disease management
As treatment guidelines are unclear for older breast cancer patients[20], we examined whether recommended treatment confer a survival benefit to patients over 70 years of age
The highest proportion of noncompliance with treatment was observed for chemotherapy 18% (n = 3,482), followed by radiotherapy (8%, n = 1,614), surgery (8%, n = 1604), and endocrine therapy (8%, n = 1,533) (Table 2)
Summary
Breast cancer survival has improved with significant progress in treatment and disease management. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80–2.83]), chemotherapy (1.25 [1.11–1.41]), radiotherapy (2.28 [1.94–2.69]) and endocrine therapy (1.70 [1.41–2.04]). Worse survival was observed in older patients for whom guidelines generally do not apply. With significant progress in treatment and disease management, a growing number of women are surviving breast cancer[4]. While 90% of patients in the United States live at least five years after the cancer is found[5], the corresponding proportion is lower in South-East Asia. ● Positive nodes ● Breast conserving surgery ● Tumor size > 50 mm or attached to chest wall
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