Nonconforming Breast Cancer Treatment in Elderly Women May Not Worsen Outcomes

By Will Boggs MD

NEW YORK (Reuters Health) - Many elderly women receive breast cancer treatment that does not fully conform to National Comprehensive Cancer Network (NCCN) recommendations, but this does not appear to worsen their outcomes, a retrospective study suggests.

"I hope physicians are aware that we may be able to safely alter the treatment of breast cancer in women over age 70," said Dr. Patty L. Tenofsky of The University of Kansas School of Medicine-Wichita and Ascension Via Christi Clinic, also in Wichita.

"More large research trials need to be done on women of this age group so that we can learn how to treat their breast cancer appropriately without overtreatment or undertreatment - both of which can be harmful," she told Reuters Health by email.

Previous studies have found that elderly breast-cancer patients often receive less than the standard of care, compared with their younger counterparts. Reasons cited include older age, comorbidities and patient preferences.

Dr. Tenofsky and colleagues assessed whether nonconformity to NCCN treatment guidelines in elderly women with breast cancer had a negative impact on local recurrence, metastatic disease and disease-specific survival in their retrospective chart review of 179 women with newly diagnosed breast cancer treated in a single surgeon's practice.

Among these patients, 107 (median age, 77.7 years) received conforming treatment, and 72 (median age, 80.5 years) received nonconforming treatment.

Significantly more women in the "nonconforming" group (90.3%) than in the conforming group (76.6%) were ER/PR positive, but otherwise there were no differences between the groups in tumor size, breast cancer type, HER2 status, or nodal status.

All women in the nonconforming group were nonconforming to chemotherapy, whereas a quarter conformed to radiotherapy guidelines, 31% to hormone-treatment guidelines and 82% to surgical guidelines, the researchers report in The American Journal of Surgery.

Despite these differences, the groups did not differ significantly in breast-cancer local-recurrence rate (2.8% for the conforming group vs. 1.4% for the nonconforming group, P=0.650), metastatic disease (2.8% in both groups), or breast cancer-related deaths (7.8% vs. 10.1%, respectively, P=0.595).

All-cause mortality was significantly higher in the nonconforming group than in the conforming group (46.4% vs. 27.5%, P=0.01), but, the researchers say, this may be related to the fact that significantly more women in the nonconforming group who died were also over the age of 80 as compared with the conforming group (84.4% vs. 60.7%).

"Breast surgeons and oncologists routinely have discussions about the alteration of breast-cancer treatment based on age," Dr. Tenofsky said. "Currently I discuss the avoidance of radiation in women over 70 who have hormone-sensitive tumors and take endocrine therapy for at least 5 years. Previous research has shown that this is safe."

"I also discuss avoiding lymph node-evaluation surgery in small tumors which are hormone sensitive," she said. "Previous research has also shown this to be safe. I do not consider these 'noncompliance' since large research trials have shown that these alterations in treatment are safe."

SOURCE: https://bit.ly/2PzL2BZ The American Journal of Surgery, online December 5, 2019.

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