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. 2012 Nov 20;107(11):1901-7.
doi: 10.1038/bjc.2012.472. Epub 2012 Oct 18.

Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer

L H Land  1 , S O Dalton, M-B Jensen, M Ewertz
Affiliations

Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer

L H Land et al. Br J Cancer. .

Abstract

Background: Prevalence of comorbidity at breast cancer diagnosis increases with age and is likely to influence the likelihood of receiving treatment according to guidelines. The aim of this study was to examine the effect of breast cancer treatment on mortality, taking age at diagnosis and comorbidity into account.

Methods: Four nationwide population registries in Denmark: the Danish Civil Registration System, the Danish Breast Cancer Cooperative Group, the Danish National Patient Register, and the Danish Register of Causes of Death provided information on 62 591 women diagnosed with early-stage breast cancer, 1990-2008, of whom data on treatment were available for 39 943. Comorbidity was measured using the Charlson Comorbidity Index. Adjuvant treatment were categorised as none, chemotherapy, endocrine therapy, and unknown. Multivariable Cox modelling assessed the effect of comorbidity on breast cancer-specific mortality and other cause mortality according to treatment, adjusting for age at diagnosis and other clinical prognostic factors.

Results: The impact of comorbidity on mortality was most pronounced in patients aged 50-79 years. Patients receiving chemotherapy with mild to moderate comorbidity had HR 0.99 (95% confidence interval (CI); 0.82-1.19) and 1.06 (95% CI; 0.77-1.46) for breast cancer-specific mortality, respectively, compared with patients without comorbidity.

Conclusion: Comorbidity at breast cancer diagnosis is an independent adverse prognostic factor for death after breast cancer. We identified a subgroup of patients with mild to moderate comorbidity receiving chemotherapy who had similar breast cancer mortality as patients with no comorbidity.

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Figures

Figure 1
Figure 1
Diagram showing the study cohort according to received treatment. N, (%).
Figure 2
Figure 2
Cumulative mortality (%) from breast cancer and other causes, according to age at diagnosis and comorbidity score. (A, B) Less than 50 years, (C, D) 50–79 years, and (E, F) 80+ years. The cumulative mortality at 10 years is listed for each category.
Figure 3
Figure 3
Kaplan–Meier curves showing OS according to comorbidity score for patients (A) enrolled in treatment protocol and (B) non-enrolled in treatment protocol. The OS rate at 10 years is listed for each category.
Figure 4
Figure 4
Cumulative mortality from breast cancer for (A) low-risk patients, (B) chemotherapy, and (C) endocrine therapy. The cumulative mortality at 10 years is listed for each category.
Figure 5
Figure 5
Forest plot illustrating adjusted HR with 95% CI for breast cancer-specific mortality (A) and other cause mortality (B) in relation to CCI and adjuvant treatment, with CCI 0 as reference group.
See this image and copyright information in PMC

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