Impact of omission of surgery on survival of older patients with breast cancer

N. A. De Glas; J. M. Jonker; E. Bastiaannet; A. J.M. De Craen; C. J.H. Van De Velde; S. Siesling; G. J. Liefers; J. E.A. Portielje; M. E. Hamaker

doi:10.1002/bjs.9616

Impact of omission of surgery on survival of older patients with breast cancer

N. A. De Glas, J. M. Jonker, E. Bastiaannet, A. J.M. De Craen, C. J.H. Van De Velde, S. Siesling, G. J. Liefers, J. E.A. Portielje, M. E. Hamaker

Research output: Contribution to journal › Article › peer-review

30 Scopus citations

Abstract

Background: Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.

Methods: Patients aged 75 years and older with stage I-III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.

Results: Overall, 26292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90.8 per cent in 1995 to 69.9 per cent in 2011 (P <0.001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1.00 (95 per cent confidence interval (c.i.) 0.99 to 1.00) per year); nor did relative survival (relative excess risk 1.00 (0.98 to 1.02) per year).

Conclusion: Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.

Original language	English
Pages (from-to)	1397-1404
Number of pages	8
Journal	British Journal of Surgery
Volume	101
Issue number	11
DOIs	https://doi.org/10.1002/bjs.9616
State	Published - Oct 2014
Externally published	Yes

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@article{4b5f43942baa495099fb7920513e377c,

title = "Impact of omission of surgery on survival of older patients with breast cancer",

abstract = "Background: Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.Methods: Patients aged 75 years and older with stage I-III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.Results: Overall, 26292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90.8 per cent in 1995 to 69.9 per cent in 2011 (P <0.001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1.00 (95 per cent confidence interval (c.i.) 0.99 to 1.00) per year); nor did relative survival (relative excess risk 1.00 (0.98 to 1.02) per year).Conclusion: Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.",

author = "{De Glas}, {N. A.} and Jonker, {J. M.} and E. Bastiaannet and {De Craen}, {A. J.M.} and {Van De Velde}, {C. J.H.} and S. Siesling and Liefers, {G. J.} and Portielje, {J. E.A.} and Hamaker, {M. E.}",

note = "Publisher Copyright: {\textcopyright} 2014 BJS Society Ltd.",

year = "2014",

month = oct,

doi = "10.1002/bjs.9616",

language = "English",

volume = "101",

pages = "1397--1404",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "11",

}

TY - JOUR

T1 - Impact of omission of surgery on survival of older patients with breast cancer

AU - De Glas, N. A.

AU - Jonker, J. M.

AU - Bastiaannet, E.

AU - De Craen, A. J.M.

AU - Van De Velde, C. J.H.

AU - Siesling, S.

AU - Liefers, G. J.

AU - Portielje, J. E.A.

AU - Hamaker, M. E.

PY - 2014/10

Y1 - 2014/10

N2 - Background: Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.Methods: Patients aged 75 years and older with stage I-III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.Results: Overall, 26292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90.8 per cent in 1995 to 69.9 per cent in 2011 (P <0.001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1.00 (95 per cent confidence interval (c.i.) 0.99 to 1.00) per year); nor did relative survival (relative excess risk 1.00 (0.98 to 1.02) per year).Conclusion: Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.

AB - Background: Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.Methods: Patients aged 75 years and older with stage I-III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.Results: Overall, 26292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90.8 per cent in 1995 to 69.9 per cent in 2011 (P <0.001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1.00 (95 per cent confidence interval (c.i.) 0.99 to 1.00) per year); nor did relative survival (relative excess risk 1.00 (0.98 to 1.02) per year).Conclusion: Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.

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JO - British Journal of Surgery

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Impact of omission of surgery on survival of older patients with breast cancer

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