Treatment Patterns and Clinical Outcomes in Elderly Patients with Breast Cancer

Purpose@#Although the number of elderly patients with breast cancer is increasing as the population ages, their treatment is controversial. We evaluated the prognostic factors associated with survival in elderly breast cancer patients and assessed the impact of comorbidity on prognosis. @*Methods@#This study included 362 patients (aged ≥65 years) who underwent surgery for breast cancer in our institution between 2003 and 2014. The patients were divided into early-aged (65–74 years) and late-aged (≥75 years) groups. Comorbidity was parametrized using the Charlson comorbidity index (CCI). Kaplan–Meier analysis was used to analyze overall survival (OS) and distant metastasis-free survival (DMFS). Prognostic factors were evaluated by Cox proportional hazards regression. @*Results@#The surgical method, subtypes, stage, and oncological features were similar between early- and late-aged groups; however, smaller proportions of patients in the late-aged group received chemotherapy (12.9% vs. 45.5%) and endocrine therapy (55.3% vs. 73.3%). In multivariable analysis, the poor prognostic factors associated with DMFS and OS were high CCI, high histologic grade, and advanced stage. Chemotherapy, endocrine therapy, and radiotherapy were not significantly related to DMFS and OS. @*Conclusion@#In this study, adjuvant treatments did not affect the prognosis of elderly patients with breast cancer. To clarify the effects of adjuvant therapies in these patients, a large-scale retrospective study that considers not only tumor characteristics but also life expectancy is necessary.

Contralateral Breast Cancer and Ipsilateral Breast Tumor Recurrence in BRCA1/2 Carriers and Non-Carriers at High-Risk of Hereditary Breast Cancer / 한국유방암학회지

Distress Screening and Management in Early Breast Cancer Patients: Distress after Breast Cancer Diagnosis and Associated Factors

PURPOSE: The aims of this study were to evaluate the magnitude of distress after breast cancer diagnosis and to investigate factors associated with distress, as well as to determine the effectiveness of psychological intervention. METHODS: This study was performed retrospectively, reviewing 264 patients who underwent breast cancer surgery at Seoul National University Bundang Hospital between November 2011 and May 2014. Distress was measured using the distress thermometer (DT) and Center for Epidemiological Studies-Depression scale (CES-D) questionnaires before, as well as at 3 and 6 months postsurgery. Psychological intervention was recommended to high risk patients (DT score ≥5 or CES-D score ≥16). RESULTS: In total, 149 patients (56.4%) were classified as high risk in the initial assessment. In the following assessments, the proportion of those in the high risk group was 38.5% and 25.0% at 3 and 6 months postsurgery, respectively. Mastectomy was significantly associated with high levels of distress compared to breast-conserving surgery in the univariate (p=0.048) and multivariate analyses (p=0.014). However, there was no significant relationship between any of the various socioeconomic factors and distress. Distress level was reduced over time in both scales. Of the 149 high risk patients, only 21 received the psychological intervention. Using linear mixed models, the psychological intervention resulted in marginally significant reductions in DT (p=0.051) and CES-D (p=0.077) scores. CONCLUSION: More than half of patients experienced distress upon initial diagnosis, and the determined surgery type was an important factor associated with high distress level. It is important to identify high risk patients and to manage distress during the initial phase.