Initiation of adjuvant chemotherapy and trastuzumab for human epidermal growth receptor 2-positive early invasive breast cancer in a population-based cohort study of older women in England

Melissa Ruth Gannon*, David Dodwell, Yasmin Jauhari, Kieran Horgan, Karen Clements, Jibby Medina, David Alan Cromwell

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    3 Citations (Scopus)

    Abstract

    Background: Clinical guidance on recommended treatment for older patients with breast cancer is often ambiguous, particularly in the context of comorbidities and poor functional status. Older patients, aged 70 years and over, account for a substantial proportion of women with breast cancer yet are underrepresented in randomized controlled trials. This paper investigates the initiation of adjuvant chemotherapy and trastuzumab in older patients in routine care. Materials and methods: Women, aged 50 years and over, newly diagnosed with human epidermal growth receptor 2 (HER2)-positive early invasive breast cancer from January 2014 to December 2017 were identified from the England Cancer Registry. Chemotherapy and trastuzumab use was obtained from the Systemic Anti-Cancer Therapy (SACT) dataset. Patient and tumor characteristics influential in treatment decision-making were included in multilevel mixed-effects logistic regression models. Results: 10% of women had HER2-positive tumors. Initiation of adjuvant chemotherapy and trastuzumab decreased with age from ≥70% among women aged 50–64 years to <15% among women aged 80+ years. Initiation varied additionally by tumor characteristics and number of comorbidities. Age remained a factor in treatment decisions despite favorable other factors, with lower use among women aged 70+ years. There was also marked variation across geographical regions. Conclusions: In women with operable HER2-positive early invasive breast cancer, adjuvant chemotherapy plus trastuzumab was started less frequently as age increased, regardless of tumor characteristics or comorbidity burden. There was substantial variation in the proportion of women who started these treatments across the country.

    Original languageEnglish
    Pages (from-to)836-842
    Number of pages7
    JournalJournal of Geriatric Oncology
    Volume11
    Issue number5
    DOIs
    Publication statusPublished - Jun 2020

    Bibliographical note

    Funding Information:
    This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients ( NABCOP ). The Audit is commissioned by the Healthcare Quality Improvement Partnership ( HQIP ) as part of the National Clinical Audit and Patient Outcomes Programme , and funded by NHS England and the Welsh Government ( www.hqip.org.uk/national-programmes ). Neither the commissioner nor the funders had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the article for publication. The authors had full independence from the HQIP . The aim of the NABCOP is to evaluate the care of older women with breast cancer in England and Wales, and support NHS providers to improve the quality of hospital care for these women. More information can be found at www.nabcop.org.uk .

    Funding Information:
    This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients (NABCOP). The Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme, and funded by NHS England and the Welsh Government (www.hqip.org.uk/national-programmes). Neither the commissioner nor the funders had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the article for publication. The authors had full independence from the HQIP. The aim of the NABCOP is to evaluate the care of older women with breast cancer in England and Wales, and support NHS providers to improve the quality of hospital care for these women. More information can be found at www.nabcop.org.uk.

    Publisher Copyright:
    © 2020 Elsevier Inc.

    Keywords

    • Adjuvant trastuzumab
    • Early breast cancer
    • HER2-positive
    • Older women
    • Regional variation

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