Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

M.g.m Derks ,Justyna Chałubińska-Fendler ,M Kiderlen ,Maciej Trojanowski ,Wojciech Zegarski ,Lynda Wyld ,Riccardo A Audisio ,Tomasz Nowikiewicz ,E Bastiaannet ,G.j Liefers ,E Van Eycken ,Paul Walsh ,Agnieszka Kołacińska ,Sabine Siesling ,Petra G Boelens ,Johanneke E.a Portielje ,John Broggio ,Denise E Hilling ,Ana Filipa Gonçalves ,Cornelis J.h Van De Velde

doi:10.1038/s41416-018-0090-1

Abstract

BackgroundOlder patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.MethodsPopulation-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.ResultsIn total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30–6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.ConclusionsThere is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

Highlights

Cancer is a disease of the elderly; 30% of patients diagnosed with breast cancer (BC) are aged 70 years or older[1]
Patients The original data set included 829,131 patients diagnosed with BC between 2000 and 2013
Patient characteristics Stage distribution varied slightly across countries; patients from the Netherlands were more frequently diagnosed with stage I BC compared with other countries (Table 1, step 3)

Summary

Introduction

Cancer is a disease of the elderly; 30% of patients diagnosed with breast cancer (BC) are aged 70 years or older[1]. Older patients participating in trials may not be representative for the wider older population owing to selection of fitter older patients, those with higher socioeconomic status and those with good cognitive function. METHODS: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30–6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment

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