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Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010–2017

  • Epidemiology
  • Published:
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Abstract

Purpose

This study assessed chemotherapy use trends before (neoadjuvant chemotherapy [NAC]) or after surgery (adjuvant chemotherapy [AdC]) among older women with breast cancer and examined factors related to NAC receipt.

Methods

Women (> 65 years) diagnosed with stage I–III breast cancer during 2010–2017 who received NAC or AdC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. All patients were stratified into six strata based on subtype (hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR + /HER2–], HER2 + , and triple-negative breast cancer [TNBC]) and stage (I–II and III). Cochran-Armitage tests were performed to test temporal trends of NAC use in each stratum. Multivariable logistic regression analyses were performed to identify factors (sociodemographic and clinical) related to NAC use.

Results

Among included older (mean ± standard deviation: 72.3 ± 5.2 years) women (N = 8,495) with stage I–III breast cancer, NAC use increased from 11.7% (2010) to 32.6% (2017). Significant increases in NAC were found in all strata (p < .0001) with more substantial increases in HER2 + disease and TNBC compared to HR + /HER2– disease. Multivariable logistic regressions identified the youngest age category (66–69 years) and later stage as significant (p < 0.05) predictors of NAC receipt in most strata, in addition to diagnosis year.

Conclusion

Similar to the overall breast cancer population, NAC use increased among a population of older women. NAC was received by most patients with stage III HER2 + disease or TNBC in more recent years and was more common among younger elderly women and those in stage III.

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Data availability

The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data that support the findings of this study are available from the National Cancer Institute but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

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Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results Program tumor registries in the creation of the SEER-Medicare database.

Funding

This study was funded by the PhRMA Foundation (2021 Predoctoral Fellowship Health Outcomes Research PDDS 846487).

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Authors and Affiliations

  1. College of Pharmacy, The University of Texas at Austin, 2409 University Ave, Austin, TX, 78712, USA

    Hanxi Zhang, Jamie C. Barner, Leticia R. Moczygemba, Karen L. Rascati & Chanhyun Park

  2. Texas Oncology, Deke Slayton Cancer Center, Webster, TX, USA

    Dhatri Kodali

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  1. Hanxi Zhang
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  2. Jamie C. Barner
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Correspondence to Jamie C. Barner.

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Zhang, H., Barner, J.C., Moczygemba, L.R. et al. Neoadjuvant chemotherapy use trends among older women with breast cancer: 2010–2017. Breast Cancer Res Treat 193, 695–705 (2022). https://doi.org/10.1007/s10549-022-06604-5

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  • DOI: https://doi.org/10.1007/s10549-022-06604-5

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