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- Title
Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer.
- Authors
Ring, Alistair; Battisti, Nicolò Matteo Luca; Reed, Malcolm W. R.; Herbert, Esther; Morgan, Jenna L.; Bradburn, Michael; Walters, Stephen J.; Collins, Karen A.; Ward, Sue E.; Holmes, Geoffrey R.; Burton, Maria; Lifford, Kate; Edwards, Adrian; Robinson, Thompson G.; Martin, Charlene; Chater, Tim; Pemberton, Kirsty J.; Brennan, Alan; Cheung, Kwok Leung; Todd, Annaliza
- Abstract
<bold>Background: </bold>Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy.<bold>Methods: </bold>A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage.<bold>Results: </bold>Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19-0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20-0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08-0.49];BCSS: HR 0.12 [95% CI 0.03-0.44]).Transient negative quality-of-life impacts were observed.<bold>Conclusions: </bold>Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient.<bold>Trial Registration: </bold>ISRCTN 46099296.
- Subjects
RESEARCH; ANTHRACYCLINES; PATIENT satisfaction; EVALUATION research; HYDROCARBONS; TREATMENT effectiveness; COMPARATIVE studies; QUALITY of life; DRUG therapy; SURVIVAL analysis (Biometry); BREAST tumors; PROBABILITY theory; LONGITUDINAL method
- Publication
British Journal of Cancer, 2021, Vol 125, Issue 2, p209
- ISSN
0007-0920
- Publication type
journal article
- DOI
10.1038/s41416-021-01388-9