Skip to main content

Advertisement

SpringerLink
Log in

Impact of comorbidity on outcome of older breast cancer patients: a FOCUS cohort study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Older breast cancer patients often suffer from comorbid diseases, which may influence life expectancy. The aim of this study was to assess the impact of specific comorbidities on overall survival and distant recurrence free period (DRFP) of older breast cancer patients. Patients were included from the population-based FOCUS cohort which contains 3,672 breast cancer patients aged 65 years or older. The impact of comorbidity on overall survival and DRFP was analyzed using multivariable Cox proportional hazard models and Poisson regression models. Median follow-up time was 6.8 years (range 0–14.0). Irrespective of age; the number of comorbid diseases was significantly associated with worse overall survival [hazard ratio (HR) per increasing number of comorbid diseases: 1.20, 95 % confidence interval (CI) 1.13–1.27 and HR 1.09, 95 % CI 1.05–1.13 for age <75 and age ≥75, respectively]. Median follow-up time for DRFP was 5.7 years (range 0–14.0). An increasing number of comorbid diseases was associated with a decreasing risk of metastases among patients aged ≥75 (HR 0.94, 95 % CI 0.87–1.02), whereas an increasing risk was shown for patients aged <75 (HR 1.09, 95 % CI 1.01–1.19). This study shows that in older breast cancer, patients overall survival and DRFP are influenced by comorbidity. This reiterates that patient outcome is not only influenced by breast cancer, and non-cancer-related factors should be taken into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wildiers H, Kunkler I, Biganzoli L et al (2007) Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 8:1101–1115

    Article  PubMed  Google Scholar 

  2. Biganzoli L, Wildiers H, Oakman C et al (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–e160

    Article  PubMed  Google Scholar 

  3. Wildiers H, Mauer M, Pallis A et al (2013) End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer—Alliance for Clinical Trials in Oncology–International Society of Geriatric Oncology position article. J Clin Oncol 31:3711–3718

    Article  PubMed  Google Scholar 

  4. Mell LK, Jeong JH, Nichols MA et al (2010) Predictors of competing mortality in early breast cancer. Cancer 116:5365–5373

    Article  PubMed  Google Scholar 

  5. van de Water W, Markopoulos C, van de Velde CJ et al (2012) Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA 307:590–597

    PubMed  Google Scholar 

  6. Schairer C, Mink PJ, Carroll L et al (2004) Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 96:1311–1321

    Article  PubMed  Google Scholar 

  7. Yancik R, Wesley MN, Ries LA et al (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285:885–892

    Article  CAS  PubMed  Google Scholar 

  8. van de Water W, Seynaeve C, Bastiaannet E et al (2013) Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: a tamoxifen exemestane adjuvant multinational study analysis. Oncologist 18:8–13

    Article  PubMed Central  PubMed  Google Scholar 

  9. Barnett K, Mercer SW, Norbury M et al (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43

    Article  PubMed  Google Scholar 

  10. Al-Refaie WB, Vickers SM, Zhong W et al (2011) Cancer trials versus the real world in the United States. Ann Surg 254:438–442

    Article  PubMed  Google Scholar 

  11. Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341:2061–2067

    Article  CAS  PubMed  Google Scholar 

  12. World Health Organization (2012) The international statistical classification of diseases and related health problems ICD-10

  13. Conference communication: age categorization proposed at oral session, accessible for members only. Discussed at: International Society of Geriatric Oncology annual meeting; Berlin, Germany, 15–17 Oct 2009

  14. Patnaik JL, Byers T, Diguiseppi C et al (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103:1101–1111

    Article  PubMed Central  PubMed  Google Scholar 

  15. Land LH, Dalton SO, Jensen MB et al (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 131:1013–1020

    Article  PubMed  Google Scholar 

  16. Ording AG, Cronin-Fenton DP, Jacobsen JB et al (2013) Comorbidity and survival of Danish breast cancer patients from 2000–2011: a population-based cohort study. Clin Epidemiol 5:39–46

    Article  PubMed Central  PubMed  Google Scholar 

  17. Patnaik JL, Byers T, Diguiseppi C et al (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13:R64

    Article  PubMed Central  PubMed  Google Scholar 

  18. Siegelmann-Danieli N, Khandelwal V, Wood GC et al (2006) Breast cancer in elderly women: outcome as affected by age, tumor features, comorbidities, and treatment approach. Clin Breast Cancer 7:59–66

    Article  PubMed  Google Scholar 

  19. Janssen-Heijnen ML, Houterman S, Lemmens VE et al (2005) Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol 55:231–240

    Article  PubMed  Google Scholar 

  20. Janssen-Heijnen MLG, Szerencsi K, van de Schans SAM et al (2010) Cancer patients with cardiovascular disease have survival rates comparable to cancer patients within the age-cohort of 10 years older without cardiovascular morbidity. Crit Rev Oncol Hematol 76:196–207

    Article  PubMed  Google Scholar 

  21. Houterman S, Janssen-Heijnen ML, Verheij CD et al (2004) Comorbidity has negligible impact on treatment and complications but influences survival in breast cancer patients. Br J Cancer 90:2332–2337

    CAS  PubMed Central  PubMed  Google Scholar 

  22. Ring A, Sestak I, Baum M et al (2011) Influence of comorbidities and age on risk of death without recurrence: a retrospective analysis of the Arimidex, Tamoxifen alone or in combination trial. J Clin Oncol 29:4266–4272

    Article  CAS  PubMed  Google Scholar 

  23. Harris EE, Hwang WT, Urtishak SL et al (2008) The impact of comorbidities on outcomes for elderly women treated with breast-conservation treatment for early-stage breast cancer. Int J Radiat Oncol Biol Phys 70:1453–1459

    Article  PubMed  Google Scholar 

  24. Louwman WJ, Janssen-Heijnen ML, Houterman S et al (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41:779–785

    Article  CAS  PubMed  Google Scholar 

  25. Pal SK, Katheria V, Hurria A (2010) Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin 60:120–132

    Article  PubMed  Google Scholar 

  26. Hamaker ME, Jonker JM, de Rooij SE et al (2012) Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 13:e437–e444

    Article  PubMed  Google Scholar 

  27. Raji MA, Kuo Y-F, Freeman JL et al (2008) Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Arch Intern Med 168:2033–2040

    Article  PubMed Central  PubMed  Google Scholar 

  28. Robb C, Boulware D, Overcash J et al (2010) Patterns of care and survival in cancer patients with cognitive impairment. Crit Rev Oncol Hematol 74:218–224

    Article  PubMed  Google Scholar 

  29. Ording AG, Garne JP, Nystrom PM et al (2013) Comorbid diseases interact with breast cancer to affect mortality in the first year after diagnosis—a Danish nationwide matched cohort study. PLoS One 8:e76013

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Hamaker ME, Hamelinck VC, van Munster BC et al (2012) Nonreferral of nursing home patients with suspected breast cancer. J Am Med Dir Assoc 13:464–469

    Article  PubMed  Google Scholar 

  31. Lin TL, Kuo MC, Shih LY et al (2012) The impact of age, Charlson comorbidity index, and performance status on treatment of elderly patients with diffuse large B cell lymphoma. Ann Hematol 91:1383–1391

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Dutch Cancer Foundation (KWF 2007-3968). The authors would like to thank the Comprehensive Cancer Centre Netherlands (Leiden region), all participating hospitals, and M. Murk-Jansen for data collection.

Conflict of interest

The authors declare that they have no conflict of interest

Author information

Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands

    Mandy Kiderlen, Nienke A. de Glas, Esther Bastiaannet, Willemien van de Water, Cornelis J. H. van de Velde & Gerrit-Jan Liefers

  2. Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands

    Mandy Kiderlen, Esther Bastiaannet, Willemien van de Water & Anton J. M. de Craen

  3. Department of Surgery, Bronovo Hospital, The Hague, The Netherlands

    Onno R. Guicherit

  4. Department of Surgery, Haga Hospital, The Hague, The Netherlands

    Jos W. S. Merkus

  5. Department of Medical Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA

    Martine Extermann

Authors
  1. Mandy Kiderlen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nienke A. de Glas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther Bastiaannet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Willemien van de Water
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anton J. M. de Craen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Onno R. Guicherit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jos W. S. Merkus
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martine Extermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cornelis J. H. van de Velde
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gerrit-Jan Liefers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mandy Kiderlen.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 41 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kiderlen, M., de Glas, N.A., Bastiaannet, E. et al. Impact of comorbidity on outcome of older breast cancer patients: a FOCUS cohort study. Breast Cancer Res Treat 145, 185–192 (2014). https://doi.org/10.1007/s10549-014-2917-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-014-2917-7

Keywords

Search

Navigation