Mariano Caroline, Lund Jennifer L, Peacock Hinton Sharon, Htoo Phyo, Muss Hyman, Reeder-Hayes Katherine E
University of British Columbia, Royal Columbian Hospital, Department of Medicine, New Westminster, British Columbia, Canada.
Department of Epidemiology, University of North Carolina at Chapel Hill, United States.
J Geriatr Oncol. 2017 Jul;8(4):242-248. doi: 10.1016/j.jgo.2017.05.005. Epub 2017 Jun 7.
The incidence of treatment-related toxicity for adjuvant chemotherapy in breast cancer is well documented in clinical trials. However, the effect of chemotherapy on functional outcomes in older patients is less well known. We identified a cohort of older women diagnosed with early stage breast cancer to examine the association between exposure to chemotherapy and a claims-based measure of function-related adverse events (FAE).
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset, we identified women aged ≥66 diagnosed with stage I or II breast cancer from 2004 to 2011. FAE were defined as one or more claims suggestive of functional impairment within 24months following chemotherapy including claims for durable medical equipment and skilled care. Women who did not receive chemotherapy were weighted to reflect the covariate distribution of chemotherapy recipients using propensity score weighting for age, stage, baseline healthcare utilization, and comorbidities.
The cohort included 44,626 patients, 6892 (15%) received chemotherapy. 19% of the population experienced ≥1 FAE. After propensity weighting, chemotherapy was associated with a small increased risk of FAEs (HR 1.12, 95% confidence interval: 1.04, 1.20). Results were similar in patients 75years and older versus younger patients. In the chemotherapy group, the highest risk of FAE occurred in the first 3months, but persisted through follow-up.
Exposure to chemotherapy was associated with a small increased risk of FAE which did not vary by age. These data can be used to inform treatment decision making for older patients with breast cancer who are eligible for adjuvant chemotherapy.
乳腺癌辅助化疗相关毒性的发生率在临床试验中有充分记录。然而，化疗对老年患者功能结局的影响尚鲜为人知。我们确定了一组被诊断为早期乳腺癌的老年女性队列，以研究化疗暴露与基于索赔的功能相关不良事件（FAE）测量之间的关联。
使用监测、流行病学和最终结果（SEER）-医疗保险数据集，我们确定了2004年至2011年期间年龄≥66岁、被诊断为I期或II期乳腺癌的女性。FAE被定义为化疗后24个月内一项或多项提示功能受损的索赔，包括耐用医疗设备和专业护理的索赔。未接受化疗的女性使用倾向评分加权法进行加权，以反映化疗接受者在年龄、分期、基线医疗保健利用率和合并症方面的协变量分布。
该队列包括44626名患者，6892名（15%）接受了化疗。19%的人群经历了≥1次FAE。倾向加权后，化疗与FAE风险小幅增加相关（风险比1.12，95%置信区间：1.04，1.20）。75岁及以上患者与年轻患者的结果相似。在化疗组中，FAE的最高风险发生在最初3个月，但在随访期间持续存在。
化疗暴露与FAE风险小幅增加相关，且不随年龄变化。这些数据可用于为符合辅助化疗条件的老年乳腺癌患者的治疗决策提供参考。
