ABSTRACT
Background: Hormone receptor positive (HR+), human epidermal growth factor receptor
2 negative (HER2-) is the most common biologic subtype of breast cancer.
Although adjuvant therapy has demonstrated a survival benefit in clinical
trials, its use is poorly understood in the real-world among elderly breast
cancer patients since age is a barrier to receiving adjuvant therapy. An
examination of treatment patterns and outcomes associated with receipt of
adjuvant/neoadjuvant therapy among elderly HR + HER2-breast
cancer patients was undertaken. Methods: There were 18,470 HR + HER2-breast
cancer patients from the linked SEER-Medicare database. Patients were diagnosed
with stage I-III disease between 1/1/2007-12/31/2011, ≥66 years, enrolled in
Medicare Parts A, B and D, and underwent breast cancer surgery after diagnosis.
Time-varying Cox proportional hazards regression assessed overall survival. Results: There were 13,670 (74%)
patients treated with adjuvant/neoadjuvant therapy and 4800 (26%) untreated.
Compared to treated patients, untreated patients were older, had earlier stage,
lower grade, smaller tumors, poorer performance, higher comorbidity score, and
less use of a 21-gene recurrence score (RS) assay (p < 0.0001). In the
survival model, increasing age, stage, tumor size, tumor grade, comorbidity
score and poor performance were significantly associated with higher mortality
risks, while use of an RS assay was associated with lower risks. The Cox model showed a 48%
higher risk of death in untreated compared to treated patients. In a subset of
8967 patients with stage I disease, tumor size < 2.0 cm and grade 1/2;
untreated patients had a 22% higher risk of death compared to treated patients. Conclusions: Older patients with
favorable clinical characteristics (earlier stage, smaller tumor, lower grade)
are less likely to be treated and have a higher risk of death compared to
adjuvant/neoadjuvant treated patients. An unmet need among older breast cancer
patients persists.
Share and Cite:
Satram-Hoang, S. , Stein, A. , Cortazar, P. , Momin, F. and Reyes, C. (2019) Increased Mortality Risk among Early Stage Hormone Receptor Positive Breast Cancer Patients Who Did Not Receive Adjuvant or Neoadjuvant Therapy.
Journal of Cancer Therapy,
10, 1-20. doi:
10.4236/jct.2019.101001.