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Is guideline-adherent adjuvant treatment an equal alternative for patients aged >65 who cannot participate in adjuvant clinical breast cancer trials? A retrospective multi-center cohort study of 4,142 patients

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

It is well accepted that innovation in oncology is transported through randomized clinical trials (CT), furthermore there is some evidence that patients profit from participation in CT. However, especially elderly patients aged >65 usually do not have access to clinical trials; we therefore used an unselected patient cohort to investigate the following questions:

  1. (1)

    Is there a difference in survival parameters between study participants <65 and elderly 65–80 non-participants?

  2. (2)

    Is guideline-adherent adjuvant treatment an equal alternative for elderly patients aged 65–80?

Materials and methods

This German retrospective multi-center cohort study included 4,142 patients (study participants <65 and elderly breast cancer patients 65–80) with primary breast cancer recruited from 1992 to 2008 in 17 participating breast cancer centers.

Results

Applying the exclusion criteria, we included 960 (23.2 %) study participants (PA) <65 and 3,182 (76.8 %) elderly >65. Elderly non-participants (NPA) >65 demonstrate a significantly inferior RFS [RFS: HR = 1.67; p < 0.001] and OS [OS: HR = 1.98; p < 0.001] compared to PA <65. Within the elderly group, 1,868 (58.7 %) patients received guideline-adherent adjuvant treatment. When comparing guideline conform elderly >65 versus PA <65, we found no significant difference in RFS [RFS: HR = 1.17; p = 0.218] and OS [OS: HR = 1.34; p = 0.054]. In contrast, non-guideline-adherent elderly demonstrated significantly inferior survival parameters [RFS: HR = 2.06; p < 0.001] [OS: HR = 2.50; p < 0.001] compared to <65 PA.

Conclusion

Guideline-adherent adjuvant treatment seems to be an equivalent option for elderly breast cancer patients. There is a strong association between guideline adherence and improved outcome parameters in elderly breast cancer patients.

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References

  1. Badve S, Dabbs DJ, Schnitt SJ et al (2011) Basal-like and triple-negative breast cancers: a critical review with an emphasis on the implications for pathologists and oncologists. Mod Pathol 24(2):157

    Article  PubMed  Google Scholar 

  2. Rakha EA, Ellis IO (2009) Triple-negative/basal-like breast cancer: review. Pathology 41(1):40–47

    Article  PubMed  Google Scholar 

  3. Pal SK, Childs BH, Pegram M (2011) Triple negative breast cancer: unmet medical needs. Breast Cancer Res Treat 125(3):627–636

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Haberland J, Bertz J, Görsch B, Dölle R, Kurth BM (2006) Future cancer incidents in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49(5):459–467

    Article  CAS  PubMed  Google Scholar 

  5. Marubini E, Mariani L, Salvadori B et al (1996) Results of a breast cancer surgery trial compared with observational data from routine practice. Lancet 347(9007):1000–1003

    Article  CAS  PubMed  Google Scholar 

  6. Schmoor C, Olschewski M, Schumacher M (1996) Randomized and non-randomized patients in clinical trials: experiences with comprehensive cohort studies. Stat Med 5(3):263–271

    Article  Google Scholar 

  7. Mayers C, Panzarella T, Tannock IF (2001) Analysis of the prognostic effects of inclusion in a clinical trial and of myelosuppression on survival after adjuvant chemotherapy for breast carcinoma. Cancer 91(12):2246–2257

    Article  CAS  PubMed  Google Scholar 

  8. Schwentner L, Van Ewijk J, Kurzeder C, Hoffmann I, König J, Kreienberg R, Blettner M, Wöckel A (2013) Participation in adjuvant clinical breast cancer trials: does study participation improve survival compared to guideline adherent adjuvant treatment? A retrospective multi-centre cohort study of 9,433 patients. Eur J Cancer 49(3):553–563

    Article  CAS  PubMed  Google Scholar 

  9. Schouten LJ, Jager JJ, van den Brandt PA (1993) Quality of cancer registry data: a comparison of data provided by clinicians with those of registrations personnel. Br J Cancer 68(5):974–977

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Wolters R, Regierer AC, Schwentner L et al (2012) A comparison of international breast cancer guidelines-do the national guidelines differ in treatment recommendations? Eur J Cancer 248(1):1–11

    Article  Google Scholar 

  11. Kreienberg R, Kopp I, Albert U, et al (2008) Interdisciplinary S3 guideline for diagnosis and therapy of breast cancer in women. German cancer society, http://www.krebsgesellschaft.de/download/interdiszipl._s3-ll_mamma_080211.pdf

  12. Janssen-Heijnen ML, Maas HA, Lemmens VE et al (2005) The correlation of age and comorbidity with therapy and survival in cancer patients in North-Brabant and North-Limburg, 1995–2001. Ned Tijdschr Geneeskd 149(30):1686–1690

    CAS  PubMed  Google Scholar 

  13. DeMichele A, Putt M, Zhang Y, Glick JH, Norman S (2003) Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients. Cancer 97(9):2150–2159

    Article  PubMed  Google Scholar 

  14. Craft PS, Buckingham JM, Dahlstrom JE et al (2010) Variation in the management of early breast cancer in rural and metropolitan centres: implications fort he organisation of rural cancer services. Breast 19(5):396–401

    Article  PubMed  Google Scholar 

  15. Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G (2004) Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with nodal negative breast cancer. J Clin Oncol 22(18):3685–3693

    Article  PubMed  Google Scholar 

  16. Schwamm LH, Fonarow GC, Reeves MJ et al (2008) Get with guidelines-stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation 119(1):107–115

    Article  PubMed  Google Scholar 

  17. Wöckel A, Kurzeder C, Geyer V et al (2010) Effects of guideline adherence in primary breast cancer—a 5 year multi-center cohort study of 3,976 patients. Breast 19:120–127

    Article  PubMed  Google Scholar 

  18. Hamaker ME, Schreurs WH, Uppelschoten JM, Smorenburg CH (2009) Breast cancer in the elderly: retrospective study on diagnosis and treatment according to national guidelines. Breast J 15:26–33

    Article  PubMed  Google Scholar 

  19. Schwentner L, Wolters R, Wischnewsky MB, Kreienberg R, Wöckel A (2012) Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: a multi-centre cohort study of 5,292 patients. Breast 21(2):171–177

    Article  PubMed  Google Scholar 

  20. Schwentner L, Wolters R, Koretz K et al (2012) Triple-negative breast cancer: the impact of guideline-adherent adjuvant treatment on survival-a retrospective multi-centre cohort study. Breast Cancer Res Treat 132(3):1073–1080

    Article  CAS  PubMed  Google Scholar 

  21. Hancke K, Denkinger MD, König J et al (2010) Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Oncol 21(4):748–753

    Article  CAS  PubMed  Google Scholar 

  22. Wolters R, Wöckel A, Novopashenny I et al (2013) Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival and is there a role for guideline adherent adjuvant therapy? A retrospective multi-center cohort study of 8,935 patients. Breast Cancer Res Treat 142(3):579–590

    Article  CAS  PubMed  Google Scholar 

  23. Goldhirsch A, Wod WC, Gelber RD, Coates AS, Thürlimann B, Senn HJ (2007) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18(7):1133–1144

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We express our thanks to the following persons for their contributions to the BRENDA study: Karsten Gnauert (Ostalbklinikum, Aalen), Steffen Fritz (Kreisklinik Biberach), Ulf Göretzlehner (Kreiskrankenhaus Ehingen), Hans-Walter Vollert (Städt. Krankenhaus Friedrichshafen), Peter Jakob Albert (Klinikum Heidenheim), Ricardo Felberbaum (Klinikum Kempten), Andreas Zorr (Klinikum Konstanz), Felix Flock (Klinikum Memmingen), Erik Schlicht (Stauferklinik, Mutlangen), Martina Gropp-Meier (Oberschwabenklinik Ravensburg), Gerhard Bartzke (Kreiskrankenhaus Rottweil), Andreas Rempen (Diakonie-Krankenhaus, Schwäbisch Hall), Edgar Schelble (Kreiskrankenhaus Sigmaringen), Theodor Dinkelacker (Helfenstein-Klinik Geislingen), Andreas Grüneberger (Oberschwabenklinik Wangen) and Thorsten Kühn (Städt. Kliniken, Esslingen). This study was supported by the German Federal Ministry of Education and Research (BMBF-Grant-01ZP0505).

Conflict of interest

All authors declare that there are no potential conflicts of interest including any financial, personal or other relationships with other people or organizations within that could inappropriately influence this work.

Ethical standard

This study and the project BRENDA have been approved by the ethics committee of the University of Ulm.

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Authors and Affiliations

  1. Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany

    R. Van Ewijk, S. Singer & M. Blettner

  2. Department of Gynaecology and Obstetrics, University Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Germany

    A. Wöckel

  3. Department of Gynaecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany

    T. Gundelach, K. Hancke, W. Janni, R. Kreienberg & L. Schwentner

Authors
  1. R. Van Ewijk
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  2. A. Wöckel
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  3. T. Gundelach
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  4. K. Hancke
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  5. W. Janni
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  6. S. Singer
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  7. R. Kreienberg
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  8. M. Blettner
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  9. L. Schwentner
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Corresponding author

Correspondence to L. Schwentner.

Additional information

R. Van Ewijk and A. Wöckel contributed equally.

For the BRENDA study group.

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Van Ewijk, R., Wöckel, A., Gundelach, T. et al. Is guideline-adherent adjuvant treatment an equal alternative for patients aged >65 who cannot participate in adjuvant clinical breast cancer trials? A retrospective multi-center cohort study of 4,142 patients. Arch Gynecol Obstet 291, 631–640 (2015). https://doi.org/10.1007/s00404-014-3438-7

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  • DOI: https://doi.org/10.1007/s00404-014-3438-7

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