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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2013

01-04-2013 | Epidemiology

Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis

Authors: N. A. de Glas, M. Kiderlen, E. Bastiaannet, A. J. M. de Craen, W. van de Water, C. J. H. van de Velde, G. J. Liefers

Published in: Breast Cancer Research and Treatment | Issue 2/2013

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Abstract

Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. The FOCUS cohort is a detailed retrospective cohort of all breast cancer patients aged 65 years and older who were diagnosed between 1997 and 2004 in the South-West of the Netherlands. Risk factors for postoperative complications were assessed using univariable and multivariable logistic regression models. One-year survival and overall survival were calculated using univariable and multivariable Cox Regression models, and relative survival was calculated according to the Ederer II method. 3179 patients received surgery, of whom 19 % (n = 618) developed 1 or more postoperative complication(s). The odds ratio of having postoperative complications increased with age [OR 1.85 (95 % confidence interval (CI) 1.37–2.50, p = 0.001) in patients >85 years] and number of concomitant diseases [OR 1.71 (95 % CI 1.30–2.24, p ≤ 0.001) for 4 or more concomitant diseases]. One-year overall survival, overall survival, and relative survival were worse in patients with postoperative complications [multivariable HR 1.49 (95 % CI 1.05–2.11), p = 0.025. HR 1.21, (95 % CI 1.07–1.36), p = 0.002 and RER 1.19 (95 % CI 1.05–1.34), p = 0.006 respectively]. Stratified for comorbidity, relative survival was lower in patients without comorbidity only. Increasing number of concomitant disease increased the risk of postoperative complications. Although elderly patients with comorbidity did have a higher risk of postoperative complications, relative mortality was not higher in this group. This suggests that postoperative complications in itself did not lead to higher relative mortality, but that the high relative mortality was most likely due to geriatric parameters such as comorbidity or poor physical function.
Literature
1.
Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, Hurria A, Extermann M, Girre V, Brain E, Audisio RA, Bartelink H, Barton M, Giordano SH, Muss H, Aapro M (2007) Management of breast cancer in elderly individuals: recommendations of the international society of geriatric oncology. Lancet Oncol 8:1101–1115PubMedCrossRef
2.
Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6:376–380PubMedCrossRef
3.
Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowske K, Moore DH, Slattery ML, Tammemagi M, Castillo A, Melisko M, Esserman L, Weltzien EK, Caan BJ (2010) Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst 102:1468–1477PubMedCrossRef
4.
Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, van der Geest LG, Janssen-Heijnen ML, Dekkers OM, van de Velde CJ, Westendorp RG (2010) Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 124:801–807PubMedCrossRef
5.
van de Water W, Markopoulos C, van de Velde CJ, Seynaeve C, Hasenburg A, Rea D, Putter H, Nortier JW, de Craen AJ, Hille ET, Bastiaannet E, Hadji P, Westendorp RG, Liefers GJ, Jones SE (2012) Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA 307:590–597PubMedCrossRef
6.
Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R (2012) Management of elderly patients with breast cancer: updated recommendations of the international society of geriatric oncology (SIOG) and European society of breast cancer specialists (EUSOMA). Lancet Oncol 13:e148–e160PubMedCrossRef
7.
8.
van de Water W, Bastiaannet E, Dekkers OM, de Craen AJ, Westendorp RG, Voogd AC, van de Velde CJ, Liefers GJ (2012) Adherence to treatment guidelines and survival in patients with early-stage breast cancer by age at diagnosis. Br J Surg 99:813–820PubMedCrossRef
9.
Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M (2007) Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or = 65 years. Br J Cancer 96:1197–1203PubMedCrossRef
10.
Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41:779–785PubMedCrossRef
11.
Land LH, Dalton SO, Jensen MB, Ewertz M (2012) Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008. Breast Cancer Res Treat 131:1013–1020PubMedCrossRef
12.
Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA (2011) Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med 26:783–790PubMedCrossRef
13.
14.
Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW (2007) Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 43:2179–2193PubMedCrossRef
15.
Houterman S, Janssen-Heijnen ML, Verheij CD, Louwman WJ, Vreugdenhil G, van der Sangen MJ, Coebergh JW (2004) Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Br J Cancer 90:2332–2337PubMed
16.
World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. WHO, Geneva, pp 1–267
17.
Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103:1101–1111PubMedCrossRef
18.
Dignam JJ, Huang L, Ries L, Reichman M, Mariotto A, Feuer E (2009) Estimating breast cancer-specific and other-cause mortality in clinical trial and population-based cancer registry cohorts. Cancer 115:5272–5283PubMedCrossRef
19.
Winther LL, Cronin-Fenton D, Garne JP, Kroman N, Silliman R, Lash TL (2012) Predictors of re-operation due to post-surgical bleeding in breast cancer patients: a Danish population-based cohort study. Eur J Surg Oncol 38:407–412CrossRef
20.
de BC, Ogunleye AA, Momoh AO, Colakoglu S, Tobias AM, Sharma R, Houlihan MJ, Lee BT (2012) High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 255:551–555CrossRef
21.
Vandenbroucke JP (2004) When are observational studies as credible as randomised trials? Lancet 363:1728–1731PubMedCrossRef
22.
Hind D, Wyld L, Reed MW (2007) Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: cochrane review. Br J Cancer 96:1025–1029PubMedCrossRef
Metadata
Title
Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis
Authors
N. A. de Glas
M. Kiderlen
E. Bastiaannet
A. J. M. de Craen
W. van de Water
C. J. H. van de Velde
G. J. Liefers
Publication date
01-04-2013
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2013
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-013-2462-9

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