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Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy

  • Epidemiology
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Abstract

Limited data are available regarding patterns of chemotherapy receipt and treatment-related toxicities for older women receiving adjuvant trastuzumab-based therapy. We used surveillance, epidemiology and end results (SEER)-Medicare data to identify patients ≥66 years with stage I–III breast cancer treated during 2005–2009, who received trastuzumab-based therapy. We examined patterns of chemotherapy receipt, and using multivariable logistic regression, we examined associations of age and comorbidity with non-standard chemotherapy. In propensity-weighted cohorts of women receiving standard and non-standard trastuzumab-based therapy, we also examined rates of (1) hospital events during the first 6 months of chemotherapy and (2) short-term survival. Among 2,106 women, 29.7 % were aged ≥76 and 66 % had a comorbidity score = 0. Overall, 31.3 % of women received non-standard chemotherapy. Compared to patients aged 66–70, older patients more often received non-standard chemotherapy [adjusted odds ratio (OR) = 4.1, 95 % confidence interval (CI) = 3.40–4.92 (ages 76–80); OR = 15.3, 95 %CI = 9.92–23.67 (age ≥ 80)]. However, comorbidity was not associated with receipt of non-standard chemotherapy. After propensity score adjustment, hospitalizations were more frequent in the standard (vs. non-standard) group (adjusted OR = 1.7, 95 % CI = 1.29–2.24). With a median follow-up of 2.8 years, 276 deaths occurred; the adjusted hazard ratio (HR) for death was lower in standard versus non-standard treated women (HR = 0.69, 95 % CI = 0.52–0.91). Among a population-based cohort of older women receiving trastuzumab, nearly one-third received non-standard chemotherapy, with the highest rates among the oldest women. Non-standard chemotherapy was associated with fewer toxicity-related hospitalizations but worse survival. Further exploration of treatment toxicities and outcomes for older women with HER2-positive breast cancer is warranted.

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Acknowledgments

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The study was supported by the National Cancer Institute Specialized Program of Research Excellence in Breast Cancer (NIH P50 CA089393), the CJL Foundation (to W T Barry), ACT NOW fund, Susan G. Komen for the Cure (to E P Winer and N L Keating), Fundacao para a Ciencia e Tecnologia (HMSP-ICS/0004/2011, Career Development Award) (to I Vaz-Luis) and a Dana-Farber Cancer Institute Friends Grant (to R Freedman).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Rachel A. Freedman, Ines Vaz-Luis, Nancy U. Lin & Eric P. Winer

  2. Instituto de Medicina Molecular, Lisbon, Portugal

    Ines Vaz-Luis

  3. Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    William T. Barry

  4. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Huichuan Lii

  5. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Nancy L. Keating

  6. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Nancy L. Keating

Authors
  1. Rachel A. Freedman
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  2. Ines Vaz-Luis
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  3. William T. Barry
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  4. Huichuan Lii
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  7. Nancy L. Keating
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Corresponding author

Correspondence to Rachel A. Freedman.

Appendix

Appendix

See Tables 4, 5, and 6.

Table 4 J-codes used to identify chemotherapy regimens
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Table 5 International classification of diseases 9 (ICD9) codes used to define hospital events [15, 16]
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Table 6 Characteristics among women who received non-standard and standard chemotherapy, after propensity weighting, %
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Freedman, R.A., Vaz-Luis, I., Barry, W.T. et al. Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy. Breast Cancer Res Treat 145, 491–501 (2014). https://doi.org/10.1007/s10549-014-2968-9

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