M Judy Lubas, Jill Hasler, Jordan Fredette, Ana Sandoval-Leon, Richard Bleicher, Austin Williams, Lindsay Taylor, Joshua Meyer, Rebecca Shulman
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引用次数: 0
Abstract
Background: Older patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early-stage breast cancer (HPEsBC) typically undergo breast-conserving surgery (BCS) followed by adjuvant radiation therapy (RT) and/or endocrine therapy (ET). Our study aimed to identify predictors of low ET adherence and evaluate the role of RT in modifying survival among patients with low ET adherence.
Methods: A retrospective analysis was performed using a US-based, electronic health record-derived, de-identified database. Patients aged ≥65 years with HPEsBC treated with BCS from 2011 to 2018 were included. Four adjuvant treatment groups were identified. Low ET adherence was defined as ET use for <80% of the 5-year post surgery follow-up period. Multinomial logistic regression was used to identify predictors of low adherence. Survival outcomes were assessed using hazard ratios (HRs) adjusted for covariates.
Results: A total of 1,488 patients were included in the study. Among patients receiving ET, 23% demonstrated low adherence. After adjustment for covariates, mortality was higher for RT alone (HR = 1.79, p = .011) and no adjuvant therapy (HR = 2.65, p < .001) compared with ET + RT. Predictors of low ET adherence included increasing age (odds ratio [OR] = 1.06, p < .010) and treatment at an academic practice (OR = 2.58, p < .001). A 10% decline in ET adherence was associated with increased mortality (HR = 1.17, p < .001). An interaction analysis revealed no differential effect of RT in the context of ET adherence.
Conclusion: Low ET adherence occurred in approximately one-quarter of patients and was associated with advancing age and treatment at academic centers. Reduced ET adherence was linked to significantly increased mortality. Further investigation into the role of RT in patients with low ET adherence is warranted.
期刊介绍：
Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.
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