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. 2022 Mar:163:189-199.
doi: 10.1016/j.ejca.2021.12.018. Epub 2022 Jan 23.

Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands - A comparison of two national prospective longitudinal multi-centre cohort studies

Willeke G van der Plas-Krijgsman  1 , Jenna L Morgan  2 , Nienke A de Glas  1 , Anna Z de Boer  3 , Charlene L Martin  4 , Geoffrey R Holmes  5 , Susan E Ward  5 , Tim Chater  5 , Malcolm W Reed  6 , Jos W S Merkus  7 , Thijs van Dalen  8 , Annelie J E Vulink  9 , Leander van Gerven  10 , Onno R Guicherit  11 , Eugenie Linthorst-Niers  12 , Titia E Lans  13 , Esther Bastiaannet  14 , Johanneke E A Portielje  1 , Gerrit Jan Liefers  14 , Lynda Wyld  4
Affiliations

Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands - A comparison of two national prospective longitudinal multi-centre cohort studies

Willeke G van der Plas-Krijgsman et al. Eur J Cancer. 2022 Mar.

Abstract

Background: Previous studies have shown that survival outcomes for older patients with breast cancer vary substantially across Europe, with worse survival reported in the United Kingdom. It has been hypothesised that these differences in survival outcomes could be related to treatment variation.

Objectives: We aimed to compare patient and tumour characteristics, treatment selection and survival outcomes between two large prospective cohorts of older patients with operable breast cancer from the United Kingdom (UK) and The Netherlands.

Methods: Women diagnosed with operable breast cancer aged ≥70 years were included. A baseline comprehensive geriatric assessment was performed in both cohorts, with data collected on age, comorbidities, cognition, nutritional and functional status. Baseline tumour characteristics and treatment type were collected. Univariable and multivariable Cox regression models were used to compare overall survival between the cohorts.

Results: 3262 patients from the UK Age Gap cohort and 618 patients from the Dutch Climb cohort were included, with median ages of 77.0 (IQR: 72.0-81.0) and 75.0 (IQR: 72.0-81.0) years, respectively. The cohorts were generally comparable, with slight differences in rates of comorbidity and frailty. Median follow-up for overall survival was 4.1 years (IQR 2.9-5.4) in Age Gap and 4.3 years (IQR 2.9-5.5) in Climb. In Age Gap, both the rates of primary endocrine therapy and adjuvant hormonal therapy after surgery were approximately twice those in Climb (16.6% versus 7.3%, p < 0.001 for primary endocrine therapy, and 62.2% versus 38.8%, p < 0.001 for adjuvant hormonal therapy). There was no evidence of a difference in overall survival between the cohorts (adjusted HR 0.94, 95% CI 0.74-1.17, p = 0.568).

Conclusions: In contrast to previous studies, this comparison of two large national prospective longitudinal multi-centre cohort studies demonstrated comparable survival outcomes between older patients with breast cancer treated in the UK and The Netherlands, despite differences in treatment allocation.

Keywords: Breast cancer; Geriatric oncology; Older patients; Survival.

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Conflict of interest statement

Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PET versus primary surgery selection in Age Gap (UK) and Climb (NL) cohort∗. ∗Excluding: ER-tumours, and patients receiving neither PET nor surgery as primary treatment.
Fig. 2
Fig. 2
A. Overall Survival per cohort – all primary treatments combined. B. Overall Survival of patients receiving PET per cohort. C. Overall survival of patients receiving surgery per cohort.
See this image and copyright information in PMC

References

    1. DeSantis C., Ma J., Sauer A., Newman L., Ahmedin J. Breast cancer statistics, 2017, racial disparity in mortality by state. CA A Cancer J Clin. 2017;67(6):439–448. - PubMed
    1. Diab S.G., Elledge R.M., Clark G.M. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000;92(7):550–556. - PubMed
    1. Satariano W., Ragland D. The effect of co-morbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–110. - PubMed
    1. Wyld L., Garg D.K., Kumar I.D., Brown H., Reed M.W. Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines. Br J Cancer. 2004;90(8):1486–1491. - PMC - PubMed
    1. Wishart G., Greenberg D., Chou P., Brown C., Duffy S., Puroshotham A. Treatment and survival in breast cancer in the eastern region of England. Ann Oncol. 2010;21(2):291–296. - PMC - PubMed

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