Abstract
Background
Data are needed on how life expectancy affects treatment decisions among women ≥80 years with early stage breast cancer.
Methods
We used the linked Surveillance Epidemiology and End Results-Medicare claims dataset
from 1992 to 2005 to identify women aged ≥80 newly diagnosed with lymph node negative, estrogen receptor positive tumors, ≤5 cm. To estimate life expectancy, we matched these women to women of similar age, region,
and insurance, not diagnosed with breast cancer. We examined 5-year mortality of matched
controls by illness burden (measured with the Charlson Comorbidity Index [CCI]) using
Kaplan-Meier statistics. We examined treatments received by estimated life expectancy
within CCI levels. We further examined factors associated with receipt of radiotherapy
after breast conserving surgery (BCS).
Results
Of 9,932 women, 39.6% underwent mastectomy, 30.4% received BCS plus radiotherapy,
and 30.0% received BCS alone. Estimated 5-year mortality was 72% for women with CCIs
of 3+, yet 38.0% of these women underwent mastectomy and 22.9% received radiotherapy
after BCS. Conversely, estimated 5-year mortality was 36% for women with CCIs of 0
and 26.6% received BCS alone. Age 80–84, urban residence, higher grade, recent diagnosis,
mammography use, and low comorbidity, were factors associated with receiving radiotherapy
after BCS. Among women with CCIs of 3+ treated with BCS, 36.9% underwent radiotherapy.
Conclusions
Many women aged ≥80 with limited life expectancies receive radiotherapy after BCS for treatment of
early stage breast cancers while many in excellent health do not. More consideration
needs to be given to patient life expectancy when considering breast cancer treatments.
Keywords
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Article info
Publication history
Published online: November 14, 2011
Accepted:
October 13,
2011
Received in revised form:
September 30,
2011
Received:
August 17,
2011
Footnotes
☆Dr. Schonberg was supported by a Paul B. Beeson Career Development Award in Aging supported by the National Institute on Aging K23 [K23AG028584], The John A. Hartford Foundation, The Atlantic Philanthropies, The Starr Foundation, and The American Federation for Aging Research. Dr. McCarthy was supported by the American Cancer Society [RSGT-10-080-CPHSPS]. There are no financial disclosures.
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© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
