Effect of omission of surgery on survival in patients aged 80 years and older with early‐stage hormone receptor‐positive breast cancer

Anna Z. de Boer*, N.A. de Glas, P. J. Marang-van de Mheen, Olaf M. Dekkers, Sabine Siesling, Linda de Munck, Kelly de Ligt, Gerrit-Jan Liefers, Johanneke E.A. Portielje, Esther Bastiaannet

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
34 Downloads (Pure)

Abstract

Background
Surgery is increasingly being omitted in older patients with operable breast cancer in the Netherlands. Although omission of surgery can be considered in frail older patients, it may lead to inferior outcomes in non‐frail patients. Therefore, the aim of this study was to evaluate the effect of omission of surgery on relative and overall survival in older patients with operable breast cancer.

Methods
Patients aged 80 years or older diagnosed with stage I–II hormone receptor‐positive breast cancer between 2003 and 2009 were selected from the Netherlands Cancer Registry. An instrumental variable approach was applied to minimize confounding, using hospital variation in rate of primary surgery. Relative and overall survival was compared between patients treated in hospitals with different rates of surgery.

Results
Overall, 6464 patients were included. Relative survival was lower for patients treated in hospitals with lower compared with higher surgical rates (90·2 versus 92·4 per cent respectively after 5 years; 71·6 versus 88·2 per cent after 10 years). The relative excess risk for patients treated in hospitals with lower surgical rates was 2·00 (95 per cent c.i. 1·17 to 3·40). Overall survival rates were also lower among patients treated in hospitals with lower compared with higher surgical rates (48·3 versus 51·3 per cent after 5 years; 15·0 versus 19·7 per cent after 10 years respectively; adjusted hazard ratio 1·07, 95 per cent c.i. 1·00 to 1·14).

Conclusion
Omission of surgery is associated with worse relative and overall survival in patients aged 80 years or more with stage I–II hormone receptor‐positive breast cancer. Future research should focus on the effect on quality of life and physical functioning.
Original languageEnglish
Pages (from-to)1145-1153
Number of pages9
JournalBritish journal of surgery
Volume107
Issue number9
Early online date7 Apr 2020
DOIs
Publication statusPublished - 1 Aug 2020

Keywords

  • UT-Hybrid-D

Fingerprint Dive into the research topics of 'Effect of omission of surgery on survival in patients aged 80 years and older with early‐stage hormone receptor‐positive breast cancer'. Together they form a unique fingerprint.

Cite this