Associations Between Hospital Volume and Overall Survival After Surgery in Older Patients with Breast Cancer.

BACKGROUND: High-volume hospitals (HVHs) are associated with improved overall survival (OS) following surgery for breast cancer compared with low-volume hospitals (LVHs). We examined this association in patients age ≥ 80 years and described patient and treatment characteristics associated with HVHs. PATIENTS AND METHODS: The National Cancer Database was queried for women age ≥ 80 years who underwent surgery for stage I-III breast cancer between 2005 and 2014. Hospital volume was defined as the average number of cases during the year of the patient's index operation and the year prior. Hospitals were categorized into HVHs and LVHs using penalized cubic spline analysis of OS. A cutoff of ≥ 270 cases/year defined HVHs. RESULTS: Among 59,043 patients, 9110 (15%) were treated at HVHs and 49,933 (85%) at LVHs. HVHs were associated with more non-Hispanic Black and Hispanic patients, earlier stage disease (stage I 54.9% vs. 52.6%, p < 0.001), higher rates of breast-conserving surgery (BCS) (68.3% vs. 61.4%, p < 0.001), and adjuvant radiation (37.5% vs. 36.1%, p = 0.004). Improved OS was associated with surgery at a HVH (HR 0.85, CI 0.81-0.88), along with receipt of adjuvant chemotherapy (HR 0.73, CI 0.69-0.77), endocrine therapy (HR 0.70, CI 0.68-0.72), and radiation (HR 0.66, CI 0.64-0.68). CONCLUSIONS: Among patients with breast cancer age ≥ 80 years, undergoing surgery at a HVH was associated with improved OS. Patients who completed surgery at HVHs had earlier stage disease and more commonly received adjuvant radiation when appropriate. Processes of care at HVHs should be identified to improve outcomes in all settings.

Postmastectomy breast reconstruction in women aged 70 and older: An analysis of the National Cancer Database (NCDB).

BACKGROUND: Breast cancer incidence in women aged ≥70 years is steadily increasing, and many are choosing to undergo postmastectomy breast reconstruction (PMBR). We aimed to identify factors associated with PMBR, describe reconstruction types, and assess postoperative mortality and re-admission rates in women ≥70 years of age. METHODS: The National Cancer Database (NCDB) was examined between 2004 and 2015 for women aged ≥70 years with breast cancer who underwent mastectomy. Statistical analysis was performed by χ2 tests and multivariate logistic regression to select the best models for predicting PMBR and if patients underwent contralateral prophylactic mastectomy (CPM) with reconstruction. RESULTS: A total 73,973 patients met inclusion criteria and 4,552 (6.1%) underwent PMBR, of which 25% had a CPM. 48% had implant reconstruction, 36.2% underwent autologous reconstruction, and 15.1% received combination reconstruction. PMBR was more likely to be performed in patients who were White, had fewer comorbidities, were treated in the Northeast metropolitan areas, and with lower tumor stage (P < .001). CPM was more likely to be performed in patients who were White and treated in community hospitals in rural areas in the South and West. (P < .05). Although 30-day readmission rates were higher in PMBR patients (3.5% vs 2.8%, P < .001), 30 and 90-day mortality rates were lower: 0.03 and 0.2% vs 0.3 and 0.9% (P < .001). CONCLUSION: Although it is understandable that intrinsic tumor characteristics influence the role of PMBR, further research and interventions should be aimed to eliminate the differences that are seen in patient race and geographic location. Readmission and postop mortality rates are overall low and comparable to that of younger patients.