ASCO 2023: Outcomes in Older Women With Metastatic Breast Cancer Improving Over Time
Survival varied by age and breast cancer subtype
MONDAY, June 12, 2023 (HealthDay News) -- Survival outcomes have improved significantly over time among older women with metastatic breast cancer, though the improvement has been modest, according to study findings presented at the American Society of Clinical Oncology Annual Meeting, held from June 2 to 6 in Chicago.
“Over the last few decades, improvements in health care have increased life expectancy by nearly 10 years, resulting in a rise in America’s older population,” Rima Patel, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues write in the study abstract. “As age is one of the most significant risk factors for the development of cancer, there is a projected increase in the incidence of cancer in the elderly population, with the largest absolute and relative increases in breast cancer. Although treatment advances have improved outcomes for patients with metastatic breast cancer, patients in clinical trials are often younger and there is limited data for the older population.”
Patel and colleagues used data from the National Cancer Database to evaluate overall survival among women diagnosed with metastatic breast cancer at age 75 years or older during 2010 to 2019. They also assessed whether tumor features and demographic factors affected survival. There were 17,325 women in the final analysis. Among them, 39.4 percent were aged 75 to 79 years, 30.1 percent were 80 to 84 years, and 30.4 percent were 85 years or older.
The researchers found the five-year overall survival rate was 13.7 percent in 2010 and 15.2 percent in 2015 (P = 0.017). Patients aged 75 to 79 years had a higher three-year overall survival rate of 34.2 percent versus 28.7 percent for patients aged 80 to 84 years and 18.6 percent for patients aged 85 years and older (P < 0.001).
According to subtype, patients with hormone receptor (HR)-positive, HER2-negative breast cancer had the best three-year survival rate at 35.1 percent, followed by those with HR-positive, HER2-negative (32.8 percent); HER2-positive, HR-negative (20.6 percent); and HR-negative, HER2-negative (9.7 percent) breast cancer.
In a multivariable analysis, a higher comorbidity index was associated with worse outcomes (hazard ratio [HR], 1.645; 95 percent confidence interval [CI], 1.48 to 1.849). A higher income of $63,000 or more was linked to lower mortality (HR, 0.859; 95 percent CI, 0.784 to 0.941) versus income less than $38,000. Type of cancer facility did not affect mortality, but patients living in metropolitan areas with a population of more than 1 million had improved outcomes (HR, 0.829; 95 percent CI, 0.689 to 0.996) compared with those living in rural areas.
“Given the lack of clinical trial data in older patients with cancer, future studies should specifically focus on improving outcomes in this population,” the authors write.
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