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Published in: Breast Cancer Research and Treatment 2/2017

01-06-2017 | Brief Report

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)

Authors: Gretchen G. Kimmick, Brittny Major, Jonathan Clapp, Jeff Sloan, Brandelyn Pitcher, Karla Ballman, Myra Barginear, Rachel A. Freedman, Andrew Artz, Heidi D. Klepin, Jacqueline M. Lafky, Judith Hopkins, Eric Winer, Clifford Hudis, Hyman Muss, Harvey Cohen, Aminah Jatoi, Arti Hurria, Jeanne Mandelblatt

Published in: Breast Cancer Research and Treatment | Issue 2/2017

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Abstract

Purpose

Tools to estimate survival, such as ePrognosis (http://​eprognosis.​ucsf.​edu/​carey2.​php), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies.

Methods

Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0–2, 3–6, 7–10). Observed mortality rates were estimated using Kaplan–Meier methods.

Results

Patient mean age was 75.8 years (range 70–91) and 73% had stage I–IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0–2) and few (n = 18, 2% 7–10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0–2 (2% vs 5%, p = 0.001) and 3–6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7–10 (23% vs 36%, p = 0.25).

Conclusions

ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.
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Literature
2.
go back to reference Hurria A (2013) Management of elderly patients with cancer. J Natl Compr Cancer Netw 11(5 Suppl):698–701CrossRef Hurria A (2013) Management of elderly patients with cancer. J Natl Compr Cancer Netw 11(5 Suppl):698–701CrossRef
4.
5.
go back to reference Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, Partridge AH, Dressler LG, Cohen HJ, Becker HP, Kartcheske PA, Wheeler JD, Perez EA, Wolff AC, Gralow JR, Burstein HJ, Mahmood AA, Magrinat G, Parker BA, Hart RD, Grenier D, Norton L, Hudis CA, Winer EP (2009) Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 360(20):2055–2065. doi:360/20/2055. doi:10.1056/NEJMoa0810266 Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, Partridge AH, Dressler LG, Cohen HJ, Becker HP, Kartcheske PA, Wheeler JD, Perez EA, Wolff AC, Gralow JR, Burstein HJ, Mahmood AA, Magrinat G, Parker BA, Hart RD, Grenier D, Norton L, Hudis CA, Winer EP (2009) Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 360(20):2055–2065. doi:360/20/2055. doi:10.​1056/​NEJMoa0810266
6.
go back to reference Mandelblatt JS, Faul LA, Luta G, Makgoeng SB, Isaacs C, Taylor K, Sheppard VB, Tallarico M, Barry WT, Cohen HJ (2012) Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and Leukemia Group B protocol 369901. J Clin Oncol 30(21):2609–2614. doi:10.1200/JCO.2011.40.2909 CrossRefPubMedPubMedCentral Mandelblatt JS, Faul LA, Luta G, Makgoeng SB, Isaacs C, Taylor K, Sheppard VB, Tallarico M, Barry WT, Cohen HJ (2012) Patient and physician decision styles and breast cancer chemotherapy use in older women: Cancer and Leukemia Group B protocol 369901. J Clin Oncol 30(21):2609–2614. doi:10.​1200/​JCO.​2011.​40.​2909 CrossRefPubMedPubMedCentral
7.
go back to reference Mandelblatt JS, Makgoeng SB, Luta G, Hurria A, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher B, Winer EP, Hudis C, Cohen HJ, Muss HB (2013) A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901. J Geriatr Oncol 4(4):353–361. doi:10.1016/j.jgo.2013.05.004 CrossRefPubMedPubMedCentral Mandelblatt JS, Makgoeng SB, Luta G, Hurria A, Kimmick G, Isaacs C, Tallarico M, Barry WT, Pitcher B, Winer EP, Hudis C, Cohen HJ, Muss HB (2013) A planned, prospective comparison of short-term quality of life outcomes among older patients with breast cancer treated with standard chemotherapy in a randomized clinical trial vs. an observational study: CALGB #49907 and #369901. J Geriatr Oncol 4(4):353–361. doi:10.​1016/​j.​jgo.​2013.​05.​004 CrossRefPubMedPubMedCentral
8.
go back to reference Carey EC, Walter LC, Lindquist K, Covinsky KE (2004) Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med 19(10):1027–1033. doi:JGI40016. doi:10.1111/j.1525-1497.2004.40016.x Carey EC, Walter LC, Lindquist K, Covinsky KE (2004) Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med 19(10):1027–1033. doi:JGI40016. doi:10.​1111/​j.​1525-1497.​2004.​40016.​x
9.
go back to reference Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer, New YorkCrossRef Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer, New YorkCrossRef
10.
go back to reference Sprinthall RC (2011) Basic statistical analysis, 9th edn. Pearson Education, Old Tappan Sprinthall RC (2011) Basic statistical analysis, 9th edn. Pearson Education, Old Tappan
13.
go back to reference Anderson RT, Yang TC, Matthews SA, Camacho F, Kern T, Mackley HB, Kimmick G, Louis C, Lengerich E, Yao N (2014) Breast cancer screening, area deprivation, and later-stage breast cancer in Appalachia: does geography matter? Health Serv Res 49(2):546–567. doi:10.1111/1475-6773.12108 CrossRefPubMed Anderson RT, Yang TC, Matthews SA, Camacho F, Kern T, Mackley HB, Kimmick G, Louis C, Lengerich E, Yao N (2014) Breast cancer screening, area deprivation, and later-stage breast cancer in Appalachia: does geography matter? Health Serv Res 49(2):546–567. doi:10.​1111/​1475-6773.​12108 CrossRefPubMed
14.
15.
16.
go back to reference de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJ, Kroep JR, Putter H, Stiggelbout AM, Weijl NI, van de Velde CJ, Portielje JE, Liefers GJ (2014) Validity of adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol 15(7):722–729. doi:10.1016/S1470-2045(14)70200-1 de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJ, Kroep JR, Putter H, Stiggelbout AM, Weijl NI, van de Velde CJ, Portielje JE, Liefers GJ (2014) Validity of adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol 15(7):722–729. doi:10.​1016/​S1470-2045(14)70200-1
17.
go back to reference de Glas NA, Bastiaannet E, Engels CC, de Craen AJ, Putter H, van de Velde CJ, Hurria A, Liefers GJ, Portielje JE (2016) Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer 114(4):395–400. doi:10.1038/bjc.2015.466 CrossRefPubMedPubMedCentral de Glas NA, Bastiaannet E, Engels CC, de Craen AJ, Putter H, van de Velde CJ, Hurria A, Liefers GJ, Portielje JE (2016) Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer 114(4):395–400. doi:10.​1038/​bjc.​2015.​466 CrossRefPubMedPubMedCentral
Metadata
Title
Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)
Authors
Gretchen G. Kimmick
Brittny Major
Jonathan Clapp
Jeff Sloan
Brandelyn Pitcher
Karla Ballman
Myra Barginear
Rachel A. Freedman
Andrew Artz
Heidi D. Klepin
Jacqueline M. Lafky
Judith Hopkins
Eric Winer
Clifford Hudis
Hyman Muss
Harvey Cohen
Aminah Jatoi
Arti Hurria
Jeanne Mandelblatt
Publication date
01-06-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-017-4188-6

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