The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study

Yasmin Jauhari; David Dodwell; Melissa Ruth Gannon; Kieran Horgan; Karen Baker; Jibby Medina; David Alan Cromwell

doi:10.1016/j.ejso.2020.09.022

The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Background: Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. Methods: Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014–2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. Results: There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. Conclusion: Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.

Original language	English
Pages (from-to)	251-260
Number of pages	10
Journal	European Journal of Surgical Oncology
Volume	47
Issue number	2
DOIs	https://doi.org/10.1016/j.ejso.2020.09.022
Publication status	Published - Feb 2021

Bibliographical note

Funding Information:
David Dodwell also receives funding from Cancer Research UK (grant C8225/A21133 ), a cancer research and awareness charity in the United Kingdom .

Funding Information:
This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients. 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 HQIP nor the funders had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors had full independence from the Healthcare Quality Improvement Partnership.

Publisher Copyright:
© 2020

Keywords

Chemotherapy
Geriatric oncology
Surgery
Triple negative breast cancer

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ejso.2020.09.022

Cite this

Jauhari, Y., Dodwell, D., Gannon, M. R., Horgan, K., Baker, K., Medina, J., & Cromwell, D. A. (2021). The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study. European Journal of Surgical Oncology, 47(2), 251-260. https://doi.org/10.1016/j.ejso.2020.09.022

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title = "The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study",

abstract = "Background: Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. Methods: Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014–2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. Results: There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. Conclusion: Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.",

keywords = "Chemotherapy, Geriatric oncology, Surgery, Triple negative breast cancer",

author = "Yasmin Jauhari and David Dodwell and Gannon, {Melissa Ruth} and Kieran Horgan and Karen Baker and Jibby Medina and Cromwell, {David Alan}",

note = "Funding Information: David Dodwell also receives funding from Cancer Research UK (grant C8225/A21133 ), a cancer research and awareness charity in the United Kingdom . Funding Information: This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients. 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 HQIP nor the funders had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors had full independence from the Healthcare Quality Improvement Partnership. Publisher Copyright: {\textcopyright} 2020",

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Jauhari, Y, Dodwell, D, Gannon, MR, Horgan, K, Baker, K, Medina, J & Cromwell, DA 2021, 'The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study', European Journal of Surgical Oncology, vol. 47, no. 2, pp. 251-260. https://doi.org/10.1016/j.ejso.2020.09.022

The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study. / Jauhari, Yasmin; Dodwell, David; Gannon, Melissa Ruth et al.
In: European Journal of Surgical Oncology, Vol. 47, No. 2, 02.2021, p. 251-260.

Research output: Contribution to journal › Article › peer-review

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T1 - The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England

T2 - A population-based cohort study

AU - Jauhari, Yasmin

AU - Dodwell, David

AU - Gannon, Melissa Ruth

AU - Horgan, Kieran

AU - Baker, Karen

AU - Medina, Jibby

AU - Cromwell, David Alan

N1 - Funding Information: David Dodwell also receives funding from Cancer Research UK (grant C8225/A21133 ), a cancer research and awareness charity in the United Kingdom . Funding Information: This study was undertaken as part of the work by the National Audit of Breast Cancer in Older Patients. 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 HQIP nor the funders had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors had full independence from the Healthcare Quality Improvement Partnership. Publisher Copyright: © 2020

PY - 2021/2

Y1 - 2021/2

N2 - Background: Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. Methods: Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014–2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. Results: There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. Conclusion: Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.

AB - Background: Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. Methods: Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014–2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. Results: There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. Conclusion: Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.

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KW - Geriatric oncology

KW - Surgery

KW - Triple negative breast cancer

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The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study

Abstract

Bibliographical note

Keywords

UN SDGs

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