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Discontinuation of hormone therapy for elderly breast cancer patients after hypofractionated whole-breast radiotherapy

Medical Oncology volume 35, Article number: 107 (2018) Cite this article

Abstract

The purpose of the study was to examine adherence to hormone therapy (HT) in elderly breast cancer patients (≥ 65 years old) treated with hypofractionated radiotherapy. We analyzed data on 550 ER-positive breast cancer patients given hypofractionated whole-breast radiotherapy from June 2009 to September 2016. Baseline comorbidities considered in the hypertension-augmented Charlson Comorbidity Index (hCCI) were retrospectively retrieved. Total hCCI scores were classified as no comorbidity (hCCI = 0), low burden of comorbidity (hCCI = 1), and high burden of comorbidity (hCCI ≥ 2). Competing risk analysis was used to estimate the 5-year cumulative incidence of HT discontinuation. Fine and Gray models were used to estimate the adjusted subhazard ratio (SHR) of HT discontinuation by hCCI score. HT was initially prescribed for 85.6% of patients and almost all of them (468/471) took it for at least one month. It was subsequently discontinued by 45 patients (9.6%), for an overall 5-year cumulative incidence of 11.7%. The 5-year cumulative incidence of HT discontinuation rose from 3.9% in the youngest age group (65–69 years) to 23.3% in the oldest (≥ 80 years) (p = 0.005). Baseline comorbidity had some effect on the likelihood of discontinuing HT, but only among patients with a low burden of comorbidity (hCCI = 1, SHR 2.00, 95%CI 0.95–4.20). Adherence to HT was better in our sample than in the literature, probably because patients were selected and motivated to continue HT. This confirms the importance of communication with patients to improve adherence to HT. We confirmed the association between HT discontinuation and older age, while comorbidity had a limited influence.

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Author notes

  1. Francesca Bonfantini and Maria Carmen De Santis have contributed equally to this work.

Affiliations

  1. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Michela Dispinzieri, Eliana La Rocca, Laura Lozza & Maria Carmen De Santis

  2. Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy

    Michela Dispinzieri, Eliana La Rocca & Riccardo Valdagni

  3. Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Elisabetta Meneghini & Milena Sant

  4. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Negrar, Italy

    Alba Fiorentino

  5. Department of Applied Research and Technological Development (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Serena Di Cosimo

  6. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Massimiliano Gennaro

  7. Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Vito Cosentino, Emanuele Pignoli & Francesca Bonfantini

  8. Director, Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Riccardo Valdagni

Authors
  1. Michela Dispinzieri
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  2. Eliana La Rocca
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  3. Elisabetta Meneghini
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  4. Alba Fiorentino
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  5. Laura Lozza
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  9. Milena Sant
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  10. Emanuele Pignoli
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  11. Riccardo Valdagni
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  12. Francesca Bonfantini
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  13. Maria Carmen De Santis
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Corresponding author

Correspondence to Maria Carmen De Santis.

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We declare that we do not have any conflict of interest.

Ethical approval

The present study has been reviewed and approved by the Internal Review Board of the Department of Radiation Oncology 1 of National Cancer Institute, Milan, Italy.

Research involving in human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Dispinzieri, M., La Rocca, E., Meneghini, E. et al. Discontinuation of hormone therapy for elderly breast cancer patients after hypofractionated whole-breast radiotherapy. Med Oncol 35, 107 (2018). https://doi.org/10.1007/s12032-018-1165-9

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  • DOI: https://doi.org/10.1007/s12032-018-1165-9

Keywords

  • Breast cancer
  • Hypofractionated RT
  • Compliance
  • Hormone therapy