Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: A population-based cohort study from the EURECCA Breast Cancer Group

Marloes G.M. Derks, Esther Bastiaannet, Mandy Kiderlen, Denise E. Hilling, Petra G. Boelens, Paul M. Walsh, Elizabeth Van Eycken, Sabine Siesling, John Broggio, Lynda Wyld, MacIej Trojanowski, Agnieszka Kolacinska, Justyna Chalubinska-Fendler, Ana Filipa Goncalves, Tomasz Nowikiewicz, Wojciech Zegarski, Riccardo A. Audisio, Gerrit Jan Liefers, Johanneke E.A. Portielje, Cornelis J.H. van de Velde (Corresponding Author)

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Abstract

Background: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.

Methods: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.

Results: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P <.001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.

Conclusions: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

Original languageEnglish
Pages (from-to)121-129
Number of pages9
JournalBritish journal of cancer
Volume119
Issue number1
DOIs
Publication statusPublished - 3 Jul 2018

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Cohort Studies
Belgium
Breast Neoplasms
Survival
Population
Ireland
England
Poland
Therapeutics
Netherlands
Registries
Breast
Guidelines
Research
Neoplasms

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Derks, Marloes G.M. ; Bastiaannet, Esther ; Kiderlen, Mandy ; Hilling, Denise E. ; Boelens, Petra G. ; Walsh, Paul M. ; Van Eycken, Elizabeth ; Siesling, Sabine ; Broggio, John ; Wyld, Lynda ; Trojanowski, MacIej ; Kolacinska, Agnieszka ; Chalubinska-Fendler, Justyna ; Goncalves, Ana Filipa ; Nowikiewicz, Tomasz ; Zegarski, Wojciech ; Audisio, Riccardo A. ; Liefers, Gerrit Jan ; Portielje, Johanneke E.A. ; van de Velde, Cornelis J.H. / Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries : A population-based cohort study from the EURECCA Breast Cancer Group. In: British journal of cancer. 2018 ; Vol. 119, No. 1. pp. 121-129.
@article{dc8e986f91ed451fb6759d7b2c3b295b,
title = "Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: A population-based cohort study from the EURECCA Breast Cancer Group",
abstract = "Background: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.Methods: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.Results: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6{\%} (Netherlands) to 84.6{\%} (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0{\%} (Belgium) and 50.8{\%} (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95{\%}CI 1.30-6.72, P <.001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.Conclusions: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.",
author = "Derks, {Marloes G.M.} and Esther Bastiaannet and Mandy Kiderlen and Hilling, {Denise E.} and Boelens, {Petra G.} and Walsh, {Paul M.} and {Van Eycken}, Elizabeth and Sabine Siesling and John Broggio and Lynda Wyld and MacIej Trojanowski and Agnieszka Kolacinska and Justyna Chalubinska-Fendler and Goncalves, {Ana Filipa} and Tomasz Nowikiewicz and Wojciech Zegarski and Audisio, {Riccardo A.} and Liefers, {Gerrit Jan} and Portielje, {Johanneke E.A.} and {van de Velde}, {Cornelis J.H.}",
year = "2018",
month = "7",
day = "3",
doi = "10.1038/s41416-018-0090-1",
language = "English",
volume = "119",
pages = "121--129",
journal = "British journal of cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "1",

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Derks, MGM, Bastiaannet, E, Kiderlen, M, Hilling, DE, Boelens, PG, Walsh, PM, Van Eycken, E, Siesling, S, Broggio, J, Wyld, L, Trojanowski, M, Kolacinska, A, Chalubinska-Fendler, J, Goncalves, AF, Nowikiewicz, T, Zegarski, W, Audisio, RA, Liefers, GJ, Portielje, JEA & van de Velde, CJH 2018, 'Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: A population-based cohort study from the EURECCA Breast Cancer Group', British journal of cancer, vol. 119, no. 1, pp. 121-129. https://doi.org/10.1038/s41416-018-0090-1

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries : A population-based cohort study from the EURECCA Breast Cancer Group. / Derks, Marloes G.M.; Bastiaannet, Esther; Kiderlen, Mandy; Hilling, Denise E.; Boelens, Petra G.; Walsh, Paul M.; Van Eycken, Elizabeth; Siesling, Sabine; Broggio, John; Wyld, Lynda; Trojanowski, MacIej; Kolacinska, Agnieszka; Chalubinska-Fendler, Justyna; Goncalves, Ana Filipa; Nowikiewicz, Tomasz; Zegarski, Wojciech; Audisio, Riccardo A.; Liefers, Gerrit Jan; Portielje, Johanneke E.A.; van de Velde, Cornelis J.H. (Corresponding Author).

In: British journal of cancer, Vol. 119, No. 1, 03.07.2018, p. 121-129.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries

T2 - A population-based cohort study from the EURECCA Breast Cancer Group

AU - Derks, Marloes G.M.

AU - Bastiaannet, Esther

AU - Kiderlen, Mandy

AU - Hilling, Denise E.

AU - Boelens, Petra G.

AU - Walsh, Paul M.

AU - Van Eycken, Elizabeth

AU - Siesling, Sabine

AU - Broggio, John

AU - Wyld, Lynda

AU - Trojanowski, MacIej

AU - Kolacinska, Agnieszka

AU - Chalubinska-Fendler, Justyna

AU - Goncalves, Ana Filipa

AU - Nowikiewicz, Tomasz

AU - Zegarski, Wojciech

AU - Audisio, Riccardo A.

AU - Liefers, Gerrit Jan

AU - Portielje, Johanneke E.A.

AU - van de Velde, Cornelis J.H.

PY - 2018/7/3

Y1 - 2018/7/3

N2 - Background: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.Methods: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.Results: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P <.001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.Conclusions: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

AB - Background: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.Methods: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.Results: In total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30-6.72, P <.001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.Conclusions: There is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

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U2 - 10.1038/s41416-018-0090-1

DO - 10.1038/s41416-018-0090-1

M3 - Article

AN - SCOPUS:85048129747

VL - 119

SP - 121

EP - 129

JO - British journal of cancer

JF - British journal of cancer

SN - 0007-0920

IS - 1

ER -