Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer

Gretchen G. Kimmick, Xiangrong Li, Steven T. Fleming, Susan A. Sabatino, J. Frank Wilson, Joseph Lipscomb, Rosemary D Cress, Carmen Bergom, Roger T. Anderson, Xiao Cheng Wu

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Abstract

Objectives: To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death. Materials and methods: Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses. Results: Of 5852 patients, 76% were under 70. years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p. <. 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95% CI 1.08-5.24), but not in younger patients (HR = 1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR = 3.79, 95% CI 1.72-8.33). Conclusions: Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.

Original languageEnglish (US)
JournalJournal of Geriatric Oncology
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Adjuvant Chemotherapy
Comorbidity
Breast Neoplasms
Neoplasms
Guidelines
Therapeutics
Mortality
Medical Records
Registries
Physicians
Drug Therapy
Population

Keywords

  • Adjuvant chemotherapy
  • Age
  • Breast cancer
  • Comorbidity
  • Risk-benefit
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

Cite this

Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer. / Kimmick, Gretchen G.; Li, Xiangrong; Fleming, Steven T.; Sabatino, Susan A.; Wilson, J. Frank; Lipscomb, Joseph; Cress, Rosemary D; Bergom, Carmen; Anderson, Roger T.; Wu, Xiao Cheng.

In: Journal of Geriatric Oncology, 01.01.2017.

Research output: Contribution to journalArticle

Kimmick, Gretchen G. ; Li, Xiangrong ; Fleming, Steven T. ; Sabatino, Susan A. ; Wilson, J. Frank ; Lipscomb, Joseph ; Cress, Rosemary D ; Bergom, Carmen ; Anderson, Roger T. ; Wu, Xiao Cheng. / Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer. In: Journal of Geriatric Oncology. 2017.
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abstract = "Objectives: To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death. Materials and methods: Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses. Results: Of 5852 patients, 76{\%} were under 70. years old and 69{\%} received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79{\%} vs. 51{\%}; p. <. 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95{\%} CI 1.08-5.24), but not in younger patients (HR = 1.78, 95{\%} CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95{\%} CI 1.52-3.62), and those with severe comorbidity (HR = 3.79, 95{\%} CI 1.72-8.33). Conclusions: Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.",
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T1 - Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer

AU - Kimmick, Gretchen G.

AU - Li, Xiangrong

AU - Fleming, Steven T.

AU - Sabatino, Susan A.

AU - Wilson, J. Frank

AU - Lipscomb, Joseph

AU - Cress, Rosemary D

AU - Bergom, Carmen

AU - Anderson, Roger T.

AU - Wu, Xiao Cheng

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death. Materials and methods: Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses. Results: Of 5852 patients, 76% were under 70. years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p. <. 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95% CI 1.08-5.24), but not in younger patients (HR = 1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR = 3.79, 95% CI 1.72-8.33). Conclusions: Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.

AB - Objectives: To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death. Materials and methods: Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses. Results: Of 5852 patients, 76% were under 70. years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p. <. 0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR] = 2.38, 95% CI 1.08-5.24), but not in younger patients (HR = 1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR = 2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR = 3.79, 95% CI 1.72-8.33). Conclusions: Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.

KW - Adjuvant chemotherapy

KW - Age

KW - Breast cancer

KW - Comorbidity

KW - Risk-benefit

KW - Survival

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