Treatment of Elderly Patients With Breast Cancer Varies Throughout Europe

ECC 2015: Treatment of Elderly Patients With Breast Cancer Varies Throughout Europe

By The ASCO Post
We are NOT the only nation on the earth These are results of a superb sturdy of almost 120.000 elderly patients with breast cancer. Many factors affect the reason for the diversity and there is a lot to learn here starting with how fortunate and relatively homogenous we are in the US and that we ARE not the rest of the world. Furthermore participation of elderly patients with breast cancer in the US  in clinical trials is negligible so we do not know  what is best for who and this is in a disease which is predominantly in older patients. Not admirable and these results suggest there are probably some very big differences as regards outcomes from treatments and we are about to hit the silver tsunami of an aging population without having more than personal experience and the retrospective o controlled prospective power of a clinical trial to go on. Thank God at least we will have this data soon. Dr Kevin Ryan

Key Points:

  • The omission of surgery for elderly patients with breast cancer was lowest in Belgium at 15%, followed by the Netherlands at 28%. The highest was in Ireland, at 37%.
  • The use of adjuvant hormone therapy in older patients with stage I disease was the lowest in the Netherlands at 21%, while in Ireland, Belgium, Portugal, and Poland, the use of adjuvant hormonal therapy varied between 82% and 88%.
  • In elderly patients with stage III disease, the use of chemotherapy was the lowest in the Netherlands at 9%, followed by Ireland (26%), Belgium (30%), and Portugal (58%), and the highest in Poland, at 78%.

First results from the largest international comparison of the treatment of elderly patients with breast cancer have shown substantial differences in the use of surgery, hormone therapy, and chemotherapy among European countries. The European Registration of Cancer Care (EURECCA) study compared the treatment patterns of 119,125 patients aged 70 and older in Belgium, Ireland, the Netherlands, Portugal, Poland, and the United Kingdom diagnosed with nonmetastatic (stage I, II, or III) breast cancer between 2000 and 2014. The study also compared the number of patients alive 5 years after breast cancer diagnosis.

Marloes Derks, MD, a PhD student in the Department of Surgery at the Leiden University Medical Center, explained at the 2015 European Cancer Congress that the results (Abstract 1808) from the EURECCA study will be used to find treatment approaches that are associated with improved outcomes in elderly patients with breast cancer. “Our research findings will contribute to improved treatment guidelines for elderly patients with breast cancer, which will lead to a more personalized treatment approach for this vulnerable patient group,” she said.

Study Findings

“Based on a comparison of data from Belgium, Ireland, and the Netherlands, surgery was omitted most frequently in older patients with stage III breast cancer. The omission of surgery was lowest in Belgium at 15%, followed by the Netherlands at 28%. The highest was in Ireland, at 37%,” said Dr. Derks.

The use of hormone therapy and chemotherapy in Belgium, Ireland, the Netherlands, Portugal, and Poland varied substantially depending on the stage of the breast cancer.

“For instance, the use of adjuvant hormone therapy in older patients with stage I disease was the lowest in the Netherlands at 21%, whereas in Ireland, Belgium, Portugal, and Poland, the use of adjuvant hormonal therapy varied between 82% and 88%. Chemotherapy use was the lowest in the Netherlands for all stages of breast cancer in elderly patients. For example, in elderly patients with stage III disease, the use of chemotherapy was the lowest in the Netherlands at 9%, followed by Ireland (26%), Belgium (30%), and Portugal (58%), and the highest in Poland, at 78%,” said Dr. Derks.

“Our initial results show that there are large treatment differences among different European countries due to a lack of evidence for the treatment of older patients with breast cancer. With this study, we hope to be able to raise awareness about this specific group of patients, and we also hope that it will lead to more research in order to develop evidence-based treatment guidelines for older patients with breast cancer.”

Dr. Derks and her colleagues are currently calculating the number of patients alive 5 years after breast cancer diagnosis. “Initial findings from the relative survival analysis using data from Belgium, Ireland, and the Netherlands have shown that elderly patients diagnosed with stage II and III breast cancer in Ireland and Belgium have a better relative survival compared to the Netherlands. We will be able to compare the treatments for different stages of the disease and to identify approaches that are linked to improved outcomes in elderly patients with breast cancer,” said Dr. Derks.

Focus on Older Patients Needed

Breast cancer is mainly a disease of old age, and 40% of new breast cancer cases occur in patients aged 65 and older. With increasing life expectancy and an aging population, this percentage is expected to rise. However, most research is focused on younger patients.

“In clinical trials, patients included are younger and fitter than older patients with breast cancer,” said Dr. Derks. “Older patients are not comparable with younger patients, as they often suffer from other diseases apart from breast cancer. They also have a higher risk of complications after breast surgery and more often experience adverse events associated with hormone therapy and chemotherapy. Consequently, research results found in younger patients cannot be directly translated to the older population with breast cancer. Therefore, clinical studies that include patients of all ages are better suited to investigate treatment approaches in elderly patients with breast cancer,” she noted.

“In order to improve treatment approaches and outcomes in elderly patients with breast cancer, more observational studies based on data from large national population registries of older patients are needed. The quality of these national registries should be improved, and a European collaboration to share this data should be encouraged. Furthermore, with regard to the increasing number of older patients with breast cancer, there is an urgent need to conduct age-specific clinical trials,” Dr. Derks concluded.

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