Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer
Por:
Minicozzi P, Van Eycken L, Molinie F, Innos K, Guevara M, Marcos-Gragera R, Castro C, Rapiti E, Katalinic A, Torrella A, Žagar T, Bielska-Lasota M, Giorgi Rossi P, Larrañaga N, Bastos J, Sánchez MJ, Sant M and European HR Working Group on breast cancer
Publicada:
1 may 2019
Ahead of Print:
8 nov 2018
Resumen:
Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (<= 6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = -0.9), but prompt treatment weakly (R = -0.01/-0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.
Filiaciones:
Minicozzi P:
Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
Van Eycken L:
Research Department, Belgian Cancer Registry, Brussels, Belgium
Molinie F:
Loire-Atlantique/Vendée Cancer Registry, Nantes, France
SIRIC-ILIAD, CHU Nantes, Nantes, France
Innos K:
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
Guevara M:
Navarra Cancer Registry, Public Health Institute of Navarra, IDISNA, Pamplona, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Marcos-Gragera R:
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Epidemiology Unit and Girona Cancer Registry, Department of Health, Catalan Institute of Oncology (ICO), Girona, Spain
Castro C:
Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
Rapiti E:
Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
Katalinic A:
University of Lübeck, Institute for Social Medicine and Epidemiology, Lübeck, Germany
:
Castellón Cancer Registry, Epidemiology Unit, Public Health Department, Castellón, Spain
Žagar T:
Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
Bielska-Lasota M:
Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health (NIH), Warsaw, Poland
Giorgi Rossi P:
Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
Larrañaga N:
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Public Health Department of Gipuzkoa, Donostia, Spain
Bastos J:
EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
Portuguese Institute of Oncology Francisco Gentil (IPO Coimbra), Coimbra, Portugal
Sánchez MJ:
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
Andalusian School of Public Health, Granada Cancer Registry, Granada, Spain
Biomedical Research Institute of Granada (ibs. Granada), Granada, Spain
Sant M:
Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
Open Access
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