Chemotherapy Treatment Pattern and Survival Outcomes among Elderly Breast Cancer Women

• Main Authors: Yi-Chen Tsai, 蔡宜臻
• Other Authors: Yi-Hsin Yang
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/84550717644949284632

碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 105 === Introduction Treatment management in elderly women should be concerned. Elderly patients had more comorbidity and worse of adherence, so the effect of adjuvant chemotherapy (ACT) or other managements still remain uncertain. In Taiwan, the incidence of breast cancer in elderly patients (aged over 65 years old) accounted for 15.48% in 2005, and 19.84% in 2013. Therefore, the treatment management and the adherence of chemotherapy for breast cancer patients was an important issue. Methods We managed a population-base retrospective cohort study with Taiwan National Health Insurance Research Database (NHIRD), Death Registry Database and Taiwan Cancer Registry Database. Women who were newly diagnosed with breast cancer after 2007 was included to our study, and then follow up until December 31, 2014. Patient with age under 20 was excluded from the population. The differences of treatment patterns by different stages were conducted between the elderly (aged over 65) and young population. Then, we analyzed the survival effect of different chemotherapy, cycles and adherence by different stages. The definition of adherence was that patients receiving at least the recommended cycles of chemotherapy. For example, the guideline recommended 6 cycles for CMF, and if patients receiving at least 6 cycles, those patients were adherence to chemotherapy. We analyzed survival with Kaplan-Meier estimate, Log-rank test, and Cox regression. Results In our study, there were 77,340 newly diagnosed patients included for analyzing whether the management in elderly was less aggressive. Elderly patients receive more hormone therapy, and less chemotherapy. Common treatments of elderly patients were hormone therapy alone or surgery alone or OP plus HT. In chemotherapy, elderly patients receiving CMF, taxane-based, or anthracycline-based were included into this population (N=3,117). In taxane-based group (N=1,784), there were 1,454 patients achieving adherence (81.5%); in anthracycline-based group (N=914), there were 800 patients achieving adherence (87.53%); in CMF regimen group (N=419), there were 338 patients achieving adherence (80.67%). For the overall survival outcome, taxane-based group showed the worse survival, while CMF showed the best outcome. For the overall adherence in elderly patients, patients with adherence showed no benefit on overall survival result compared to patients with non-adherence, but the difference was not significant. For each chemotherapy group, Patients with recommended cycles in taxane-based (6-8 cycles) and anthracycline-based (4-6 cycles) group showed some benefit on OS in stage III, and early stages, respectively. Conclusions In our study, in Taiwan, elderly breast cancer women received less aggressive treatments comparing with young patients. The most common managements in elderly breast cancer women were surgery and hormone therapy. The OS in Taxane-based group was not superior to CMF-regimen and anthracycline-based group. For chemotherapy adherence in elderly patients, adherence group had worse survival than non-adherence group.