Abstract
ObjectivesForty percent of breast cancers occur among older patients. Unfortunately, there is a lack of evidence for treatment guidelines for older breast cancer patients. The aim of this study is to compare treatment strategy and relative survival for operable breast cancer in the elderly between The Netherlands and Ireland.Material and MethodsFrom the Dutch and Irish national cancer registries, women aged ≥65 years with non-metastatic breast cancer were included (2001-2009). Proportions of patients receiving guideline-adherent locoregional treatment, endocrine therapy, and chemotherapy were calculated and compared between the countries by stage. Secondly, 5-year relative survival was calculated by stage and compared between countries.ResultsOverall, 41,055 patients from The Netherlands and 5,826 patients from Ireland were included. Overall, more patients received guideline-adherent locoregional treatment in The Netherlands, overall (80% vs. 68%, adjusted p<0.001), stage I (83% vs. 65%, p<0.001), stage II (80% vs. 74%, p<0.001) and stage III (74% vs. 57%, P<0.001) disease. On the other hand, more systemic treatment was provided in Ireland, where endocrine therapy was prescribed to 92% of hormone receptor-positive patients, compared to 59% in The Netherlands. In The Netherlands, only 6% received chemotherapy, as compared 24% in Ireland. But relative survival was poorer in Ireland (5 years relative survival 89% vs. 83%), especially in stage II (87% vs. 85%) and stage III (61% vs. 58%) patients.ConclusionTreatment for older breast cancer patients differed significantly on all treatment modalities between The Netherlands and Ireland. More locoregional treatment was provided in The Netherlands, and more systemic therapy was provided in Ireland. Relative survival for Irish patients was worse than for their Dutch counterparts. This finding should be a strong recommendation to study breast cancer treatment and survival internationally, with the ultimate goal to equalize the survival rates for breast cancer patients across Europe.
Highlights
About 40 per cent of all new breast cancer cases in developed countries occur among women aged 65 and older [1]
More locoregional treatment was provided in The Netherlands, and more systemic therapy was provided in Ireland
The observed discrepancies in breast cancer treatment are consistent with findings of earlier international comparisons of older and other breast cancer patients across Europe and the US [9,17,18,19]
Summary
About 40 per cent of all new breast cancer cases in developed countries occur among women aged 65 and older [1]. The proportion of elderly breast cancer patients is expected to increase in the near future [2]. Proper treatment for older breast cancer patients is difficult to define. Older women are frequently excluded from clinical treatment trials because of their age, comorbidity or logistical barriers [3]. An evidence-based treatment strategy for older women with breast cancer is lacking. The only guidance for clinicians is from treatment guidelines which have been validated in younger and healthier women [5]. Extrapolation from trials might not be valid since breast cancer biology differs in some respects in older patients, treatment tolerance varies, and there are substantial competing risks of mortality [2,6]. Clinicians have to decide what is best for their patient: treatment according to the guidelines, or patient-tailored deviation from the guidelines
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
