Delayed initiation of adjuvant chemotherapy in older women with breast cancer.
Delayed initiation of adjuvant chemotherapy in older women with breast cancer.
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DOI：
10.1002/cam4.3363
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发表时间：
2020-10
期刊：
影响因子：
4
通讯作者：
Chavez-MacGregor M
中科院分区：
文献类型：
--
作者：
Smith-Graziani D;Lei X;Giordano SH;Zhao H;Karuturi M;Chavez-MacGregor M
辅助化疗有益于早期乳腺癌（BC）患者。老年女性接受指南依从性治疗的频率较低，治疗延迟的频率较高。我们评估了与延迟辅助化疗相关的因素，以及延迟对老年BC患者生存率的影响。在SEER-Medicare和Texas Cancer Registry-Medicare数据库中确定了2001 - 2015年诊断为局部或区域性BC的年龄>66岁的患者。从手术到化疗的时间（TTC）分为四组：0 - 30、31 - 60、61 - 90和>90天。我们确定了延迟的预测因素，估计了总体（OS）和BC特异性（BCSS）生存率，并确定了TTC与调整其他变量后的结局之间的相关性。在28，968名女性（中位年龄71岁）中，中位TTC为43天。10.7%的患者TTC >90天。年龄较大、黑人或西班牙裔种族/民族、未婚状态、更多合并症、激素受体阳性、乳房切除术、Oncotype DX检测和完全状态购买与延迟风险增加相关。TTC组的5年OS估计值分别为0.82、0.81、0.80和0.74（p<.001）。BCSS表现出类似的趋势（p<.001）。化疗延迟与OS（HR=1.33，95%CI 1.25 - 1.40）和BCSS（HR=1.39，95%CI 1.27 - 1.53）较差相关。在亚组分析中，在激素受体阳性（HR=1.56，95%CI 0.97 - 2.51）、HER 2阳性（HR=1.99，95%CI 1.04 - 3.79）和三阴性（HR=2.15，95%CI 1.38 - 3.36）肿瘤患者中，延迟化疗与OS和BCSS恶化相关。化疗延迟与老年BC患者的生存率较差相关。提供者应避免延误，并在手术后≤90天开始化疗，无论患者的BC亚型或年龄如何。我们评估了与延迟启动辅助化疗相关的因素，以及延迟对大型老年乳腺癌患者人群的生存影响。我们发现术后化疗延迟超过90天对生存率有负面影响，延迟与临床和社会经济因素有关。
Adjuvant chemotherapy benefits early‐stage breast cancer (BC) patients. Older women receive guideline‐adherent treatment less frequently and experience treatment delays more frequently. We evaluated factors associated with delaying adjuvant chemotherapy and the delays’ survival impact in a large population–based cohort of elderly BC patients. Patients age >66 years diagnosed 2001‐2015 with localized or regional BC were identified in the SEER‐Medicare and Texas Cancer Registry‐Medicare databases. Time from surgery to chemotherapy (TTC) was categorized into four groups: 0‐30, 31‐60, 61‐90, and >90 days. We identified predictors of delays, estimated overall (OS) and BC‐specific (BCSS) survival, and determined the association between TTC and outcome adjusting for other variables. Among 28,968 women (median age 71 years), median TTC was 43 days. 10.7% of patients experienced TTC >90 days. Older age, Black or Hispanic race/ethnicity, unmarried status, more comorbidities, hormone receptor‐positivity, mastectomy, Oncotype DX testing, and full state buy‐in were associated with increased risk of delay. Five‐year OS estimates by TTC group were 0.82, 0.81, 0.80, and 0.74, respectively (p<.001). BCSS demonstrated a similar trend (p<.001). Chemotherapy delay was associated with worse OS (HR=1.33, 95%CI 1.25‐1.40) and BCSS (HR=1.39, 95%CI 1.27‐1.53). In subgroup analysis, delayed chemotherapy was associated with worse OS and BCSS among patients with hormone receptor–positive (HR=1.56, 95%CI 0.97‐2.51), HER2‐positive (HR=1.99, 95%CI 1.04‐3.79), and triple‐negative (HR=2.15, 95%CI 1.38‐3.36) tumors. Chemotherapy delays are associated with worse survival in older BC patients. Providers should avoid delays and initiate chemotherapy ≤90 days after surgery regardless of patients’ BC subtype or age. We evaluated the factors associated with delays in the initiating adjuvant chemotherapy and the survival impact of delays in a large population‐based cohort of elderly breast cancer patients. We found chemotherapy delays beyond 90 days after surgery negatively affected survival, and delays were associated with clinical and socioeconomic factors.
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影响因子：
3.8
作者：
Wheeler SB;Carpenter WR;Peppercorn J;Schenck AP;Weinberger M;Biddle AK
通讯作者：
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