The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer

Traci Le Masters; Suresh Madhavan; Usha Sambamoorthi

doi:doi:10.11648/j.jctr.20190703.12

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The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer

Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi

Published in Journal of Cancer Treatment and Research (Volume 7, Issue 3)

Received: 20 August 2019 Accepted: 6 September 2019 Published: 11 October 2019

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Abstract

The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.

Published in	Journal of Cancer Treatment and Research (Volume 7, Issue 3)
DOI	10.11648/j.jctr.20190703.12
Page(s)	51-61
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Breast Cancer, Guideline-concordant Care, Survival

References

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APA Style

Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi. (2019). The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. Journal of Cancer Treatment and Research, 7(3), 51-61. https://doi.org/10.11648/j.jctr.20190703.12

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ACS Style

Traci Le Masters; Suresh Madhavan; Usha Sambamoorthi. The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. J. Cancer Treat. Res. 2019, 7(3), 51-61. doi: 10.11648/j.jctr.20190703.12

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AMA Style

Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi. The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. J Cancer Treat Res. 2019;7(3):51-61. doi: 10.11648/j.jctr.20190703.12

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@article{10.11648/j.jctr.20190703.12,
  author = {Traci Le Masters and Suresh Madhavan and Usha Sambamoorthi},
  title = {The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer},
  journal = {Journal of Cancer Treatment and Research},
  volume = {7},
  number = {3},
  pages = {51-61},
  doi = {10.11648/j.jctr.20190703.12},
  url = {https://doi.org/10.11648/j.jctr.20190703.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20190703.12},
  abstract = {The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.},
 year = {2019}
}

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TY  - JOUR
T1  - The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer
AU  - Traci Le Masters
AU  - Suresh Madhavan
AU  - Usha Sambamoorthi
Y1  - 2019/10/11
PY  - 2019
N1  - https://doi.org/10.11648/j.jctr.20190703.12
DO  - 10.11648/j.jctr.20190703.12
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 51
EP  - 61
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20190703.12
AB  - The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.
VL  - 7
IS  - 3
ER  -

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Author Information

Traci Le Masters

Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States
Suresh Madhavan

Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States
Usha Sambamoorthi

Department of Pharmaceutical Systems and Policy, School of Pharmacy, University, Morgantown, West Virginia, United States

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APA Style

Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi. (2019). The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. Journal of Cancer Treatment and Research, 7(3), 51-61. https://doi.org/10.11648/j.jctr.20190703.12

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ACS Style

Traci Le Masters; Suresh Madhavan; Usha Sambamoorthi. The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. J. Cancer Treat. Res. 2019, 7(3), 51-61. doi: 10.11648/j.jctr.20190703.12

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AMA Style

Traci Le Masters, Suresh Madhavan, Usha Sambamoorthi. The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer. J Cancer Treat Res. 2019;7(3):51-61. doi: 10.11648/j.jctr.20190703.12

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@article{10.11648/j.jctr.20190703.12,
  author = {Traci Le Masters and Suresh Madhavan and Usha Sambamoorthi},
  title = {The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer},
  journal = {Journal of Cancer Treatment and Research},
  volume = {7},
  number = {3},
  pages = {51-61},
  doi = {10.11648/j.jctr.20190703.12},
  url = {https://doi.org/10.11648/j.jctr.20190703.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20190703.12},
  abstract = {The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.},
 year = {2019}
}

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TY  - JOUR
T1  - The Association Between Guideline-concordant Care and Risk for Breast Cancer and Non-breast Cancer Mortality Among Older Women with Breast Cancer
AU  - Traci Le Masters
AU  - Suresh Madhavan
AU  - Usha Sambamoorthi
Y1  - 2019/10/11
PY  - 2019
N1  - https://doi.org/10.11648/j.jctr.20190703.12
DO  - 10.11648/j.jctr.20190703.12
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 51
EP  - 61
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20190703.12
AB  - The purpose of this study is to determine how receipt of guideline-concordant care (GCC) is associated with breast cancer-specific mortality (BCSM) and non-breast cancer mortality (NBCM) among older women with breast cancer. The SEER-Medicare data was used to identify 142, 433 women age > 66 diagnosed with stage I-III breast cancer between 2007-2011. Receipt of GCC was determined according to evidence-based treatment guidelines. Cause-specific Cox proportional hazard multivariable regression models were used to estimate the association between GCC and the risk of BCSM, considering NBCM as a competing event, and NBCM, considering BCSM as a competing event, within five years of diagnosis or until end of follow-up. Among older women with breast cancer, 6.5% experienced BCSM and 11.9% experienced NBCM. GCC was associated with a 24% decreased risk of BCSM (AHR, 0.76; 95% CI, 0.71-0.82), but a 80% increased risk of NBCM (AHR, 1.80; 95% CI, 1.70-1.92). Receipt of adjuvant endocrine therapy was associated with an increased risk of BCSM and a decreased risk for NBCM. Receipt of chemotherapy was associated with an increased risk for BCSM and NBCM, while radiation therapy was associated with a decreased risk of NBCM. Women with a pre-existing dementia, arthritis, hypertension, stroke and increased comorbidity burden had an increased risk for BCSM. Most older breast cancer patients do not receive GCC, yet relatively few die from breast cancer. While GCC does decrease the risk of BCSM, the decision to treat should be made considering the patients existing health status, given that pre-existing comorbidity increases the risk for both BCSM and NBCM. Mortality differences associated with specific types of treatment may be attributed to patient selection for treatment based on worse cancer prognostic factors.
VL  - 7
IS  - 3
ER  -

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