Breast cancer is the most common type of cancer in several parts of the world and the number of elderly patients is increasing. The aim of this study was to describe stage at diagnosis, treatment, ...and relative survival of elderly patients compared to younger patients in the Netherlands. Adult female patients with their first primary breast cancer diagnosed between 1995 and 2005 were selected. Stage, treatment, and relative survival were described for young and elderly (≥65 years) patients and within the cohort of elderly patients according to 5-year age groups. Overall, 127,805 patients were included. Elderly breast cancer patients were diagnosed with a higher stage of disease. Moreover, within the elderly differences in stage were observed. Elderly underwent less surgery (99.2-41.2%); elderly received hormonal treatment as monotherapy more frequently (0.8-47.3%); and less adjuvant systemic treatment (79-53%). Elderly breast cancer patients with breast cancer had a decreased relative survival. Although relative survival was lower in the elderly, the percentage of patients who die of their breast cancer less than 50% above age 75. In conclusion, the relative survival for the elderly is lower as compared to their younger counterparts while the percentage of deaths due to other causes increases with age. This could indicate that the patient selection is poor and fit patients could suffer from “under treatment”. In the future, specific geriatric screening tools are necessary to identify fit elderly patients who could receive more “aggressive” treatment while best supportive care should be given to frail elderly patients.
Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for ...complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. The FOCUS cohort is a detailed retrospective cohort of all breast cancer patients aged 65 years and older who were diagnosed between 1997 and 2004 in the South-West of the Netherlands. Risk factors for postoperative complications were assessed using univariable and multivariable logistic regression models. One-year survival and overall survival were calculated using univariable and multivariable Cox Regression models, and relative survival was calculated according to the Ederer II method. 3179 patients received surgery, of whom 19 % (
n
= 618) developed 1 or more postoperative complication(s). The odds ratio of having postoperative complications increased with age OR 1.85 (95 % confidence interval (CI) 1.37–2.50,
p
= 0.001) in patients >85 years and number of concomitant diseases OR 1.71 (95 % CI 1.30–2.24,
p
≤ 0.001) for 4 or more concomitant diseases. One-year overall survival, overall survival, and relative survival were worse in patients with postoperative complications multivariable HR 1.49 (95 % CI 1.05–2.11),
p
= 0.025. HR 1.21, (95 % CI 1.07–1.36),
p
= 0.002 and RER 1.19 (95 % CI 1.05–1.34),
p
= 0.006 respectively. Stratified for comorbidity, relative survival was lower in patients without comorbidity only. Increasing number of concomitant disease increased the risk of postoperative complications. Although elderly patients with comorbidity did have a higher risk of postoperative complications, relative mortality was not higher in this group. This suggests that postoperative complications in itself did not lead to higher relative mortality, but that the high relative mortality was most likely due to geriatric parameters such as comorbidity or poor physical function.
Due to increasing life expectancy, patients with breast cancer remain at risk of dying due to breast cancer over a long time. This study aims to assess the impact of age on breast cancer mortality ...and other cause mortality 10 years after diagnosis.
Postmenopausal patients with hormone-receptor positive breast cancer were included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. Age at diagnosis was categorised as <65 years (n = 3369), 65–74 years (n = 1896) and ≥75 years (n = 854). Breast cancer mortality was assessed considering other cause mortality as competing event using competing risk analysis.
After a median follow-up of 9.8 years (interquartile range 8.0–10.3), cumulative incidence of breast cancer mortality increased with increasing age (age <65 years, 11.7% 95% confidence interval {CI}: 10.2–13.2; 65–74 years, 12.7% (11.2–14.2) and ≥75 years, 15.6% (13.1–18.0)). Univariate subdistribution hazard ratio (sHR) increased with increasing age (age: 65–74 years, sHR: 1.08, 95% CI: 0.92–1.27 and ≥75 years sHR: 1.30, 95% CI: 1.06–1.58, P = 0.013). Multivariable sHR adjusted for tumour and treatment characteristics increased with age but did not reach significance (age 65–74 years, sHR: 1.11, 95% CI: 0.94–1.31; ≥75 years, sHR: 1.18, 95% CI: 0.94–1.48, P = 0.055).
Ten years after diagnosis, older age at diagnosis is associated with increasing breast cancer mortality in univariate analysis, but it did not reach significance in multivariable analysis. This is not outweighed by a substantially higher other cause mortality with older age. This underlines the need to improve the balance between undertreatment and overtreatment in older patients with breast cancer. The trial was registered in International Trial Databases (ClinicalTrials.govNCT00279448, NCT00032136, and NCT00036270; the Netherlands Trial Registry NTR267).
•With increasing life expectancy, there is a longer period to die due to breast cancer.•Breast cancer mortality increased with age despite higher competing mortality.•Even at older age, breast cancer remains an important cause of death.•Older patients are at risk of both undertreatment and overtreatment.•Clinicians should aim to accurately balance harms and benefits of treatment in elderly.
In developed countries, 40% of breast cancer patients are >65 years of age at diagnosis, of whom 16% additionally suffer from diabetes. The aim of this study was to assess the impact of diabetes on ...relapse-free period (RFP) and overall mortality in elderly breast cancer patients.
Patients were selected from the retrospective FOCUS cohort, which contains detailed information of elderly breast cancer patients. RFP was calculated using Fine and Gray competing risk regression models for patients with diabetes versus patients without diabetes. Overall survival was calculated by Cox regression models, in which patients were divided into four groups: no comorbidity, diabetes only, diabetes and other comorbidity or other comorbidity without diabetes.
Overall, 3124 patients with non-metastasized breast cancer were included. RFP was better for patients with diabetes compared with patients without diabetes (multivariable HR 0.77, 95% CI 0.59–1.01), irrespective of other comorbidity and most evident in patients aged ≥75 years (HR 0.67, 95% CI 0.45–0.98). The overall survival was similar for patients with diabetes only compared with patients without comorbidity (HR 0.86, 95% CI 0.45-0.98), while patients with diabetes and additional comorbidity had the worst overall survival (HR 1.70, 95% CI 1.44–2.01).
When taking competing mortality into account, RFP was better in elderly breast cancer patients with diabetes compared with patients without diabetes. Moreover, patients with diabetes without other comorbidity had a similar overall survival as patients without any comorbidity. Possibly, unfavourable effects of (complications of) diabetes on overall survival are counterbalanced by beneficial effects of metformin on the occurrence of breast cancer recurrences.
Over 40% of breast cancer patients are diagnosed above the age of 65. Treatment of these elderly patients will probably vary over countries. The aim of this study was to make an international ...comparison (several European countries and the US) of surgical and radiation treatment for elderly women with early stage breast cancer. Survival comparisons were also made. Data were obtained from national or regional population-based registries in the Netherlands, Switzerland, Ireland, Belgium, Germany, and Portugal. For the US patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Early stage breast cancer patients aged ≥65 diagnosed between 1995 and 2005 were included. An international comparison was made for breast and axillary surgery, radiotherapy after breast conserving surgery (BCS), and relative or cause-specific survival. Overall, 204.885 patients were included. The proportion of patients not receiving any surgery increased with age in many countries; however, differences between countries were large. In most countries more than half of all elderly patients received breast conserving surgery (BCS), with the highest percentage in Switzerland. The proportion of elderly patients that received radiotherapy after BCS decreased with age in all countries. Moreover, in all countries the proportion of patients who do not receive axillary surgery increased with age. No large differences in survival between countries were recorded. International comparisons of surgical treatment for elderly women with early stage breast cancer are scarce. This study showed large international differences in treatment of elderly early stage breast cancer patients, with the most striking result the large proportion of elderly who did not undergo surgery at all. Despite large treatment differences, survival does not seem to be affected in a major way.
Precise measurements are performed on spectral line shapes of spontaneous Rayleigh-Brillouin scattering in mixtures of the noble gases Ar and Kr, with He. Admixture of a light He atomic fraction ...results in marked changes of the spectra, although in all experiments He is merely a spectator atom: it affects the relaxation of density fluctuations of the heavy constituent, but its contribution to the scattered light intensity is negligibly small. The results are compared to a theory for the spectral line shape without adjustable parameters, yielding excellent agreement for the case of binary monatomic gases, signifying a step towards modeling and understanding of light scattering in more complex molecular media.
Surgery in (pre)malignant celiac disease van de Water, Jolanda M W; Nijeboer, Petula; de Baaij, Laura R ...
World journal of gastroenterology : WJG,
11/2015, Letnik:
21, Številka:
43
Journal Article
Odprti dostop
AIM: To report the outcome of surgery in patients with(pre)malignant conditions of celiac disease(CD) and the impact on survival.METHODS: A total of 40 patients with(pre)malignant conditions of ...CD,ulcerative jejunitis(n = 5) and enteropathy associated T-cell lymphoma(EATL)(n = 35),who underwent surgery between 2002 and 2013 were retrospectively evaluated. Data on indications,operative procedure,post-operative morbidity and mortali ty,adjuvant therapy and overal l survival(OS) were collected. Eleven patients with EATL who underwent chemotherapy without resection were included as a control group for survival analysis. Patients were followed-up every three months during the first year and at 6-mo intervals thereafter.RESULTS: Mean age at resection was 62 years. The majority of patients(63%) underwent elective laparotomy. Functional stenosis(n = 1 3) and perforation(n = 12) were the major indications for surgery. In 70% of patients radical resection wasperformed. Early postoperative complications,mainly due to leakage or sepsis,occurred in 14/40(35%) of patients. Eight patients required reoperation. More patients who underwent resection in the acute setting(n = 3,20%) died compared to patients treated in the elective setting. With a median follow-up of 20 mo,seven patients(18%) required reoperation due to long-term complications. Significantly more patients who underwent acute surgery could not be treated with adjuvant chemotherapy. Patients who first underwent surgical resection showed significantly better OS than patients who received chemotherapy without resection.CONCLUSION: Although the complication rate is high,the preferred first step of treatment in(pre)malignant CD consists of local resection as early as possible to improve survival.
PDF
