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

Journal article (2020)

Authors

A de Boer Leiden University Medical Center
Nienke A. de Glas Leiden University Medical Center
P.J. Marang-van de Mheen Leiden University Medical Center
Olaf M. Dekkers Leiden University Medical Center
Sabine Siesling Netherlands Comprehensive Cancer Organisation (IKNL), University of Twente
L. de Munck Netherlands Comprehensive Cancer Organisation (IKNL), Leiden University Medical Center
Kelly M. de Ligt Netherlands Comprehensive Cancer Organisation (IKNL), University of Twente
Gerrit Jan Liefers Leiden University Medical Center
Johanneke E.A. Portielje Leiden University Medical Center
E. Bastiaannet Leiden University Medical Center
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Published Date

2020

Language

English

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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.