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Observational Study
. 2019 Jul 30;19(1):749.
doi: 10.1186/s12885-019-5930-8.

Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland

Janusz Kocik  1 , Małgorzata Pajączek  2 , Tomasz Kryczka  3   4
Affiliations
Observational Study

Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland

Janusz Kocik et al. BMC Cancer. .

Abstract

Background: Evidence is emerging that older women may tolerate breast cancer therapies equally well as the young ones, providing that they receive good supportive care. It has also been reported that these patients remain outside the current therapeutic standards. The aim of this observational study was to assess the access of breast cancer patients to medical procedures.

Methods: We retrospectively reviewed a database of breast cancer patients registered in the National Cancer Registry in Poland, searching for the numbers of new cases and deaths in the years 2010-2015. We obtained the numbers and costs of key medical procedures provided for these patients from the National Health Fund in Poland. Breast cancer survival in the years 2010-2015 was estimated based on the mortality/incidence ratio. The t-Student test and Spearman correlation coefficient were used for the analysis of data obtained from both databases.

Results: There was no increase in survival throughout the years 2010-2015 in both analysed subpopulations of all breast cancer patients below and over 65 years of age, despite an unprecedented rise in healthcare funding in Poland. We noted 37% lower probability of 5-year survival in patients older than 65 years. The average number of outpatient visits and surgical procedures per person per year were slightly, yet significantly (p < 0.01), higher in younger vs. older patients (3.9 vs. 3.4 and 1.18 vs. 1.02, respectively). Outpatient chemotherapy was more common in older patients (6.0 vs. 5.25 cycles a year per person on average, p < 0.01). There were no significant differences in the average numbers of hospitalisations for chemotherapy, frequencies of radiotherapy and in the use of targeted therapy programmes (calculated per person per year), between younger and older patients.

Conclusions: Older women with breast cancer are treated similarly to younger patients, but have significantly worse chances to survive breast cancer in Poland. A simple increase in healthcare financing will not improve the survival in the elderly with breast cancer without developing funded individualised care and survivorship programmes.

Keywords: Breast cancer; Elderly; Healthcare access; Healthcare burden; Undertreatment; Underutilization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Breast cancer age-related incidence and mortality in years 2010–2015 in Poland
Fig. 2
Fig. 2
Healthcare funding in Poland 2010–2015
Fig. 3
Fig. 3
Breast cancer survival in Poland in 2010–2015 estimated by 1-Mortality/Incidence Ratio (1-MIR) - comparison between age groups above and below 65 years
Fig. 4
Fig. 4
Changes in chemotherapy settings in age groups above 65 and below 65 years in period of 2010–2015 in Poland
See this image and copyright information in PMC

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