Skip to main content
Top
Published in: Journal of Cancer Research and Clinical Oncology 3/2003

01-03-2003 | Original Paper

A population-based study on variations in the use of adjuvant systemic therapy on postmenopausal patients with early stage breast cancer

Authors: G. Nagel, B. Röhrig, H. Hoyer, U. Wedding, D. Katenkamp

Published in: Journal of Cancer Research and Clinical Oncology | Issue 3/2003

Login to get access

Abstract

Purpose.

To assess adherence to treatment recommendations regarding adjuvant systemic therapy of postmenopausal patients with early stage breast cancer.

Methods.

A population-based cohort of women from Eastern Thuringia/Germany with first diagnosis of breast cancer in 1995–2000 was studied. The use of adjuvant therapy was assessed separately for patients with positive and negative nodal status fitting polytomous logistic regression models.

Results.

Among 396 women with positive lymph nodes and 832 with negative lymph nodes, 92.9% and 87.3% received an adjuvant systemic treatment, respectively. Age, comorbidity, hormone receptor status, histological grading, and additionally, in nodal positives, the number of involved lymph nodes, were associated with treatment patterns. Age had the strongest impact on treatment decision. Older women more often received hormone- or no adjuvant therapy. However, 26.3% of the women with lymph node involvement and positive hormone receptor status received no hormone therapy, whereas 35.7% of women with negative hormone receptor status received hormone therapy.

Conclusion.

The number of patients with adjuvant systemic therapy is high in women with positive and those with negative lymph nodes, reflecting adherence to the recommendations. Better outcome could be expected if hormone therapy was used adequately in receptor positives. Further follow-up is required to monitor the outcome and changes in adherence to treatment recommendations.
Literature
1.
go back to reference Albain KS, Green SR, Lichter AS, Hutchins LF, Wood WC, Henderson IC, Ingle JN, O'Sullivan J, Osborne CK, Martino S (1996) Influence of patient characteristics, socioeconomic factors, geography, and systemic risk on the use of breast-sparing treatment in women enrolled in adjuvant breast cancer studies: an analysis of two intergroup trials. J Clin Oncol 14:3009–3027PubMed Albain KS, Green SR, Lichter AS, Hutchins LF, Wood WC, Henderson IC, Ingle JN, O'Sullivan J, Osborne CK, Martino S (1996) Influence of patient characteristics, socioeconomic factors, geography, and systemic risk on the use of breast-sparing treatment in women enrolled in adjuvant breast cancer studies: an analysis of two intergroup trials. J Clin Oncol 14:3009–3027PubMed
2.
go back to reference Ashcroft JJ, Leinster SJ, Slade PD (1985) Breast cancer—patient choice of treatment. Preliminary communication. J R Soc Med 78:43–46 Ashcroft JJ, Leinster SJ, Slade PD (1985) Breast cancer—patient choice of treatment. Preliminary communication. J R Soc Med 78:43–46
3.
go back to reference Ayanian JZ, Guadagnoli E (1996) Variations in breast cancer treatment by patient and provider characteristics. Breast Cancer Res Tr 40:65–74 Ayanian JZ, Guadagnoli E (1996) Variations in breast cancer treatment by patient and provider characteristics. Breast Cancer Res Tr 40:65–74
4.
go back to reference Balducci L, Extermann M (2000) Management of cancer in the older person. A practical approach. Oncologist 5:224–237PubMed Balducci L, Extermann M (2000) Management of cancer in the older person. A practical approach. Oncologist 5:224–237PubMed
5.
go back to reference Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 88:716–726PubMed Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 88:716–726PubMed
6.
go back to reference Basnett I, Gill M, Tobias JS (1992) Variations in breast cancer management between a teaching and a non-teaching district. Eur J Cancer 28A:1945–1950PubMed Basnett I, Gill M, Tobias JS (1992) Variations in breast cancer management between a teaching and a non-teaching district. Eur J Cancer 28A:1945–1950PubMed
7.
go back to reference Bloom HJG, Richardson WW (1957) Histological grading and prognosis in breast cancer. B J Cancer 11:359–377 Bloom HJG, Richardson WW (1957) Histological grading and prognosis in breast cancer. B J Cancer 11:359–377
8.
go back to reference Byrne MJ, Jamrozik K, Parson RW, Fitzgerald CJ, Dewar JM, Harvey JM, Sterrett GF, Ingram DM, Sheiner HJ, Cameron (1993) Breast cancer in Western Australia in 1989. II. Diagnosis and primary management. Aust N Z J Surg 85:680–685 Byrne MJ, Jamrozik K, Parson RW, Fitzgerald CJ, Dewar JM, Harvey JM, Sterrett GF, Ingram DM, Sheiner HJ, Cameron (1993) Breast cancer in Western Australia in 1989. II. Diagnosis and primary management. Aust N Z J Surg 85:680–685
9.
go back to reference Charlson M, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383 Charlson M, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
10.
go back to reference Early Breast Cancer Trialists' Collaborative Group (1992) Systemic treatment of early breast cancer by hormonal, cytotoxoc, or immune therapy. Lancet 339:1–15PubMed Early Breast Cancer Trialists' Collaborative Group (1992) Systemic treatment of early breast cancer by hormonal, cytotoxoc, or immune therapy. Lancet 339:1–15PubMed
11.
go back to reference Early Breast Cancer Trialists' Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 352:930–942PubMed Early Breast Cancer Trialists' Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 352:930–942PubMed
12.
go back to reference Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410PubMed Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410PubMed
13.
go back to reference D´Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data base. J Clin Epidemiol 49:1429–1433CrossRefPubMed D´Hoore W, Bouckaert A, Tilquin C (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data base. J Clin Epidemiol 49:1429–1433CrossRefPubMed
14.
go back to reference Engel J, Nagel G, Breuer E, Meisner C, Albert US, Strelocke K, Sauer H, Katenkamp D, Mittermayer Ch, Heidemann E, Schulz KD, Kunath H, Lorenz W, Hoelzel D (2002) Primary breast cancer therapy in six regions of Germany. Eur J Cancer 38:578–85PubMed Engel J, Nagel G, Breuer E, Meisner C, Albert US, Strelocke K, Sauer H, Katenkamp D, Mittermayer Ch, Heidemann E, Schulz KD, Kunath H, Lorenz W, Hoelzel D (2002) Primary breast cancer therapy in six regions of Germany. Eur J Cancer 38:578–85PubMed
15.
go back to reference Extermann M, Balducci L, Lyman GH (2000) What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 18:1709–1717PubMed Extermann M, Balducci L, Lyman GH (2000) What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 18:1709–1717PubMed
16.
go back to reference Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16:1582–1587 Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16:1582–1587
17.
go back to reference Field MJ, Lohr KN (1990) Clinical practice guidelines. Institute of Medicine, Washington D.C. Field MJ, Lohr KN (1990) Clinical practice guidelines. Institute of Medicine, Washington D.C.
18.
go back to reference Ganz PA (1992) Does (or should) chronologic age influence the choice of cancer treatment? Oncology(Huntingt) 6[suppl 2]:45–49 Ganz PA (1992) Does (or should) chronologic age influence the choice of cancer treatment? Oncology(Huntingt) 6[suppl 2]:45–49
19.
go back to reference Gesetz über Krebsregister (1994) Bundesgesetztesblatt I 79:3351–3355 Gesetz über Krebsregister (1994) Bundesgesetztesblatt I 79:3351–3355
20.
go back to reference Goldhirsch A, Glick JH, Gelber RD, Senn HJ (1998) Meeting highlights: international panel on treatment of primary breast cancer. J Natl Cancer Inst 90:1601–1608PubMed Goldhirsch A, Glick JH, Gelber RD, Senn HJ (1998) Meeting highlights: international panel on treatment of primary breast cancer. J Natl Cancer Inst 90:1601–1608PubMed
21.
go back to reference Greenfield S, Blanco DM, Elashoff RM, Ganz PA (1987) Patterns of care related to age of breast cancer patients. JAMA 257:2766–2770PubMed Greenfield S, Blanco DM, Elashoff RM, Ganz PA (1987) Patterns of care related to age of breast cancer patients. JAMA 257:2766–2770PubMed
22.
go back to reference Grilli R. (2001) Specialization and cancer. Words with too many meanings should be handled with care. CMAJ 164:210–211PubMed Grilli R. (2001) Specialization and cancer. Words with too many meanings should be handled with care. CMAJ 164:210–211PubMed
23.
go back to reference Guadagnoli E, Shapiro C, Gurwitz JH, Silliman RA, Weeks JC, Borbas C, Soumerai SB (1997) Age-related patterns of care: evidence against ageism in the treatment of early stage breast cancer. J Clin Oncol 15:2338–2344PubMed Guadagnoli E, Shapiro C, Gurwitz JH, Silliman RA, Weeks JC, Borbas C, Soumerai SB (1997) Age-related patterns of care: evidence against ageism in the treatment of early stage breast cancer. J Clin Oncol 15:2338–2344PubMed
24.
go back to reference Guadagnoli E, Weeks JC, Shapiro CL, Gurwitz JH, Borbas C, Soumerai SB (1998) Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 16:101–106 Guadagnoli E, Weeks JC, Shapiro CL, Gurwitz JH, Borbas C, Soumerai SB (1998) Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 16:101–106
25.
go back to reference Hébert-Croteau N, Brisson J, Latreille J, Blanchette C, Dechenes L (1999) Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer 85:1104–1113CrossRefPubMed Hébert-Croteau N, Brisson J, Latreille J, Blanchette C, Dechenes L (1999) Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer 85:1104–1113CrossRefPubMed
26.
go back to reference Hébert-Croteau N, Brisson J, Pineault R (2000) Review of organizational factors related to care offered women with breast cancer. Epidemiol Rev 22:228–238PubMed Hébert-Croteau N, Brisson J, Pineault R (2000) Review of organizational factors related to care offered women with breast cancer. Epidemiol Rev 22:228–238PubMed
27.
go back to reference Homser DW, Lemeshow S(1989) Applied logistic regression. Wiley, New York Homser DW, Lemeshow S(1989) Applied logistic regression. Wiley, New York
28.
go back to reference International Union against Cancer (UICC) (1997) TNM classification of malignant tumours, 5th edn. Wiley, New York International Union against Cancer (UICC) (1997) TNM classification of malignant tumours, 5th edn. Wiley, New York
29.
go back to reference Kleinbaum DG (1994) Logistic regression—a self-learning text. Springer, Berlin Heidelberg New York Kleinbaum DG (1994) Logistic regression—a self-learning text. Springer, Berlin Heidelberg New York
30.
go back to reference Mandelblatt JS, Hadley J, Kerner JF, Schulman KA, Gold K, Dunmore-Griffith J, Edge S, Guadagnoli E, Lynch JJ, Meropol NJ, Weeks JC, Winn R (2000) Patterns of breast carcinoma treatment in older women. Cancer 89:561–573CrossRefPubMed Mandelblatt JS, Hadley J, Kerner JF, Schulman KA, Gold K, Dunmore-Griffith J, Edge S, Guadagnoli E, Lynch JJ, Meropol NJ, Weeks JC, Winn R (2000) Patterns of breast carcinoma treatment in older women. Cancer 89:561–573CrossRefPubMed
31.
go back to reference Mor V, Laliberte LL, Pretisek AC,Intrator O, Wachtel T, Maddock PG, Band KI (2000) Impact of breast cancer treatment guidelines on surgeon practice patterns: results of a hospital-based intervention. Surgery 128:847–861CrossRefPubMed Mor V, Laliberte LL, Pretisek AC,Intrator O, Wachtel T, Maddock PG, Band KI (2000) Impact of breast cancer treatment guidelines on surgeon practice patterns: results of a hospital-based intervention. Surgery 128:847–861CrossRefPubMed
32.
go back to reference Moritz S, Bates T, Henderson SM, Humphreys S Michell MJ (1997) Variation in the management of small invasive breast cancers detected on screening in the South-East Thames region. Observational study. BMJ 315:1266–1272PubMed Moritz S, Bates T, Henderson SM, Humphreys S Michell MJ (1997) Variation in the management of small invasive breast cancers detected on screening in the South-East Thames region. Observational study. BMJ 315:1266–1272PubMed
33.
go back to reference National Institutes of Health Consensus Development Conference Statement (2001) Adjuvant therapy for breast cancer; November 1–3, 2000. J Natl Cancer Inst 93:973–989CrossRefPubMed National Institutes of Health Consensus Development Conference Statement (2001) Adjuvant therapy for breast cancer; November 1–3, 2000. J Natl Cancer Inst 93:973–989CrossRefPubMed
34.
go back to reference Newcomb PA, Carbone PP (1993) Cancer treatment and age: patients' perspective. J Natl Cancer Inst 85:1580–1584PubMed Newcomb PA, Carbone PP (1993) Cancer treatment and age: patients' perspective. J Natl Cancer Inst 85:1580–1584PubMed
35.
go back to reference Newschaffer CJ, Penberthy L, Desch CE, Retchin SM, Whittmore M (1996) The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med 156:559–564 Newschaffer CJ, Penberthy L, Desch CE, Retchin SM, Whittmore M (1996) The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med 156:559–564
36.
go back to reference Olivotto A, Coldman AJ, Hisop TG, Trevisan CH, Kula J, Goel V, Sawka C (1997) Compliance with practice guidelines for node-negative breast cancer. J Clin Oncol 15:216–222PubMed Olivotto A, Coldman AJ, Hisop TG, Trevisan CH, Kula J, Goel V, Sawka C (1997) Compliance with practice guidelines for node-negative breast cancer. J Clin Oncol 15:216–222PubMed
37.
go back to reference Robert-Koch-Institut (RKI) (1998) Geschätzte Zahl der jährlich neu an Krebs Erkrankter. Berlin, Germany. Available at: http://www.rki.de/gbe/krebs/krebs.htm Robert-Koch-Institut (RKI) (1998) Geschätzte Zahl der jährlich neu an Krebs Erkrankter. Berlin, Germany. Available at: http://​www.​rki.​de/​gbe/​krebs/​krebs.​htm
38.
go back to reference Sainsbury R, Haward B, Rider L, Johnston C, Round C (1995) Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet 345:1265–1270PubMed Sainsbury R, Haward B, Rider L, Johnston C, Round C (1995) Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet 345:1265–1270PubMed
39.
go back to reference Satariano WA, Ragland DR (1994) The effect of co-morbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120:104–110PubMed Satariano WA, Ragland DR (1994) The effect of co-morbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120:104–110PubMed
40.
go back to reference Silliman RA, Troyan SL, Guadagnoli E, Kaplan SH, Greenfield S (1997) The impact of age, material status, and physician-patient interaction on the care of older women with breast carcinoma. Cancer 80:1326–1334CrossRefPubMed Silliman RA, Troyan SL, Guadagnoli E, Kaplan SH, Greenfield S (1997) The impact of age, material status, and physician-patient interaction on the care of older women with breast carcinoma. Cancer 80:1326–1334CrossRefPubMed
41.
go back to reference Surveillance, epidemiology and end results 1973–1998 (SEER) (2001) Available at: http://www.seer.cancer.gov (update 7/2001) Surveillance, epidemiology and end results 1973–1998 (SEER) (2001) Available at: http://​www.​seer.​cancer.​gov (update 7/2001)
42.
go back to reference Wolberg WH, Tanner MA, Romsaas EP, Trump DL, Malec JF (1987) Factors influencing options in primary breast cancer treatment. J Clin Oncol 5:68–74PubMed Wolberg WH, Tanner MA, Romsaas EP, Trump DL, Malec JF (1987) Factors influencing options in primary breast cancer treatment. J Clin Oncol 5:68–74PubMed
43.
go back to reference Yancik R (1997) Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 80:1273–1283CrossRefPubMed Yancik R (1997) Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 80:1273–1283CrossRefPubMed
44.
go back to reference Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285:885–892PubMed Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285:885–892PubMed
Metadata
Title
A population-based study on variations in the use of adjuvant systemic therapy on postmenopausal patients with early stage breast cancer
Authors
G. Nagel
B. Röhrig
H. Hoyer
U. Wedding
D. Katenkamp
Publication date
01-03-2003
Publisher
Springer-Verlag
Published in
Journal of Cancer Research and Clinical Oncology / Issue 3/2003
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-003-0417-y

Other articles of this Issue 3/2003

Journal of Cancer Research and Clinical Oncology 3/2003 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.