Treatment patterns, risk for hospitalization and mortality in older patients with triple negative breast cancer

Antonis Valachis,Pontus Nyström,Irma Fredriksson,Anna-Karin Wennstig,Johan Ahlgren

doi:10.1016/j.jgo.2020.09.004

Abstract

ObjectivesTo study the treatment patterns, potential risk factors for hospitalization within one year from diagnosis, and causes of death in older patients with triple negative breast cancer (TNBC). Materials and MethodsWe performed a registry-based cohort study using the BCBaSe database which links cases of breast cancer from three Swedish healthcare regions with socioeconomic factors, hospitalizations and causes of death. Women ≥70 years old with non-metastatic TNBC, between 1/12007 and 31/122012 were included (n = 413). ResultsIn total, 168 patients (40.7%) received chemotherapy after surgery and 123 patients (30.0%) in the whole cohort had at least one hospitalization within one year from diagnosis. The risk of hospitalization overall was increased in the group receiving chemotherapy (Odds Ratio 2.35, 95% Confidence Intervall: 1.30–4.26) mainly due to toxicities. Cumulative incidence of breast cancer mortality was comparable among different age groups (70–74 vs. 75–79 vs. ≥ 80 years old) whereas non-breast cancer mortality was higher in patients ≥80 years old. Stage at diagnosis and comorbidities were independently associated with both breast cancer-specific- and overall mortality whereas age was only associated with overall mortality. ConclusionsThe use of chemotherapy in older patients with TNBC was associated with age, tumor stage, and comorbidities. Chemotherapy use was also associated with increased risk for hospitalization within one year from diagnosis. Although the impact of chemotherapy on mortality was analyzed in a multivariate manner showing neither increased or decreased mortality, no firm conclusion can be drawn due to unmeasured confounders.

Highlights

The incidence of breast cancer is strongly related to age with higher incidence rate in older patients [1]
In our study cohort of older patients with Triple-negative breast cancer (TNBC), we found that less than half of the patients received chemotherapy as a part of curative treatment
Chemotherapy use was associated with higher risk for hospitalization within one year from breast cancer diagnosis whereas no firm conclusion with this study can be drawn about the impact of chemotherapy on survival because of the high risk for confounding by indication

Summary

Introduction

The incidence of breast cancer is strongly related to age with higher incidence rate in older patients [1]. The proportion of more favorable breast cancer subtypes increase with age, a substantial number of older patients is diagnosed with high-risk tumors [2]. Triple-negative breast cancer (TNBC) is a challenging breast cancer subtype due to the high risk for recurrence and the lack of effective systemic neo−/adjuvant treatment strategies other than chemotherapy [3]. In older patients with TNBC, the choice of systemic neo−/adjuvant therapy is even more complicated considering the deficiency of adequate evidence (limited number of older patients enrolled in clinical trials [4]) and the higher risk for toxicity. The risk for chemotherapy-related hospitalization within six months from. Adjuvant chemotherapy has been found to decrease both all-cause and cancer-specific survival in older patients with breast cancer, especially in those with hormone-receptor negative disease and lymph node involvement [6,7]

Objectives

Methods

Conclusion