Jéssica Monteiro Vasconcellos, Renata Colombo Bonadio, Sofia Vidaurre Mendes, Bruna Zanin Orsi, Letícia Vecchi Leis, Ana Paula Messias, Otávio Augusto Moreira Noschang, Maurício Baptista Pereira, Pedro José Galvão Freire, Augusto Rodrigues de Araújo Neto, Erika Andrade Rocha, Theodora Karnakis, Laura Testa
{"title":"Does Undertreatment With Chemotherapy Impact the Outcomes of Elderly Patients With Early-Stage Breast Cancer? A Real-World Data Analysis.","authors":"Jéssica Monteiro Vasconcellos, Renata Colombo Bonadio, Sofia Vidaurre Mendes, Bruna Zanin Orsi, Letícia Vecchi Leis, Ana Paula Messias, Otávio Augusto Moreira Noschang, Maurício Baptista Pereira, Pedro José Galvão Freire, Augusto Rodrigues de Araújo Neto, Erika Andrade Rocha, Theodora Karnakis, Laura Testa","doi":"10.1016/j.clbc.2025.02.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The management of breast cancer (BC) in elderly patients remains a topic of debate among specialists, with concerns regarding potential undertreatment. This study aimed to evaluate the impact of undertreatment on outcomes in older patients with early-stage BC.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients aged over 70 years with early breast cancer who were treated at an academic cancer center between 2009 and 2021.Indications for (neo)adjuvant chemotherapy (CT) were assessed based on institutional guidelines. Undertreatment was defined as patients who had an indication for CT but did not receive it. The study evaluated undertreatment rate, recurrence rate, disease-free survival, breast cancer-specific survival (BCSS), overall survival (OS), and prognostic factors.</p><p><strong>Results: </strong>A total of 1455 patients had early-stage BC. The majority of patients were between 70 and 80 years old (71%), had luminal tumors (79%), and mild comorbidities (60%). Of the 921 patients for whom (neo)adjuvant chemotherapy (CT) was indicated, 57% did not receive it, mainly due to age and comorbidities. The 5-year BCSS was 90.3% in the undertreated group compared to 86.3% in the CT group (P = .024). The 5-year OS was 76.3% in the undertreated group compared to 81% in the CT group (P = .389). Multivariable analysis identified predictors of worse OS, but undertreatment was not directly associated.</p><p><strong>Conclusion: </strong>Undertreatment rates were high in this older population, yet outcomes were not negatively impacted. Thus, not offering (neo)adjuvant CT may be a wise choice for selected elderly pts with early BC, taking into account their comorbidities and functional status.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical breast cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clbc.2025.02.007","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The management of breast cancer (BC) in elderly patients remains a topic of debate among specialists, with concerns regarding potential undertreatment. This study aimed to evaluate the impact of undertreatment on outcomes in older patients with early-stage BC.
Methods: This retrospective cohort study analyzed patients aged over 70 years with early breast cancer who were treated at an academic cancer center between 2009 and 2021.Indications for (neo)adjuvant chemotherapy (CT) were assessed based on institutional guidelines. Undertreatment was defined as patients who had an indication for CT but did not receive it. The study evaluated undertreatment rate, recurrence rate, disease-free survival, breast cancer-specific survival (BCSS), overall survival (OS), and prognostic factors.
Results: A total of 1455 patients had early-stage BC. The majority of patients were between 70 and 80 years old (71%), had luminal tumors (79%), and mild comorbidities (60%). Of the 921 patients for whom (neo)adjuvant chemotherapy (CT) was indicated, 57% did not receive it, mainly due to age and comorbidities. The 5-year BCSS was 90.3% in the undertreated group compared to 86.3% in the CT group (P = .024). The 5-year OS was 76.3% in the undertreated group compared to 81% in the CT group (P = .389). Multivariable analysis identified predictors of worse OS, but undertreatment was not directly associated.
Conclusion: Undertreatment rates were high in this older population, yet outcomes were not negatively impacted. Thus, not offering (neo)adjuvant CT may be a wise choice for selected elderly pts with early BC, taking into account their comorbidities and functional status.
期刊介绍：
Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.
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