Influence of geriatric oncology consultation on the management of breast cancer in older women: a French population-based study.

AIM: The objective of the present population-based study was to assess the impact of geriatric oncology consultation on the management of elderly patients with breast cancer and to identify the predictive factors of breast cancer treatment in this population. METHODS: A total of 206 women aged 75 years and older with breast cancer, diagnosed from January 2007 to December 2009 were included. The independent impact of geriatric oncology consultation on treatment was analyzed using multivariate logistic regression with adjustment for the other predictive factors of treatment. RESULTS: Patients who had a geriatric oncology consultation (19.4%) had more comorbidities (Charlson Comorbidity Index ≥ 1; P = 0.02), more advanced tumors (P = 0.025), more aggressive tumors (P = 0.029), were more likely to receive mastectomy and adjuvant therapy (P < 0.0001); and less likely to be treated by breast-conserving surgery and adjuvant therapy (P = 0.003). Regarding the geriatric oncology database, 36 of the 40 patients consulted a geriatrician about oncological treatment, and 27 of these 36 patients received the treatment suggested by the geriatrician. For the whole population, geriatric oncology consultation remained a positive predictor for mastectomy and adjuvant therapy (odds ratio 2.32, P = 0.043), and a negative predictor for breast-conserving surgery and adjuvant therapy (odds ratio 0.38, P = 0.048). CONCLUSIONS: In the present study, we found that treatment of patients who underwent a geriatric oncology consultation generally followed the geriatricians' recommendations. The geriatric oncology consultation was a positive predictor of mastectomy and adjuvant therapy, and a negative predictor of breast-conserving surgery and adjuvant therapy.

Population-based study of breast cancer screening in Côte d'Or (France): clinical implications and factors affecting screening round adequacy.

Factors affecting the adequacy of breast cancer screening rounds and the clinical implications of screening have been investigated in women aged 50-74 years. Questionnaires were sent to all eligible patients and to the family doctor of those patients who had died or were lost to follow-up at the time of the study. Unlike the tumour characteristics the patients' personal and family characteristics were also collected before the diagnosis. The clinical features of screening-detected tumours and those discovered on clinical signs or on metastasis were compared. On the basis of the time between two mammographies, we created the following four groups according to the recommended screening round: adequate, long, short and patients with no earlier mammography. Univariate and multivariate generalized logit models were obtained to determine factors affecting the adequacy of breast cancer screening rounds. Five hundred and thirty-three patients were included. Two hundred and seventy-seven (52%) had inadequate breast cancer screening rounds (long, short or no earlier mammography). The American Joint Committee on Cancer stage was less advanced (0/1) in screening-detected tumours and among tumours of patients with an adequate screening round (P=0.014). Multivariate analyses showed that patients with an earlier organized screening mammography (P<0.0001) and those with gynaecological follow-up (P=0.03) were more likely to have an adequate rather than an inadequate breast cancer screening round. Screening leads to the detection of early-stage tumours when it is performed according to the recommendations. Organizing mammography rounds as recommended is essential to optimize the benefits of breast cancer screening.

Time to deterioration in quality of life score as a modality of longitudinal analysis in patients with breast cancer.

PURPOSE: This prospective multicenter study explored different definitions of time to deterioration (TTD) in quality of life (QoL) scores, according to different cutoffs of the minimal clinically important difference (MCID) as a modality for longitudinal QoL assessment in breast cancer patients. METHODS: QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR-23 before surgery, after surgery, and 6 and 12 months later. The global health score, arm symptoms score (BRAS), and breast symptoms score were analyzed. For a given baseline score, QoL was considered to have deteriorated if this score decreased by ≥5 points at any time point after baseline. Analyses were repeated using an MCID of 10 points and taking the score after surgery as the reference score (to explore the occurrence of response shift). TTD was calculated using the Kaplan-Meier method and Cox regression was used to identify independent factors associated with TTD. RESULTS: Two hundred thirty-five patients underwent axillary lymph node dissection (ALND), 222 underwent sentinel lymph node biopsy (SLNB), and 61 underwent SLNB plus ALND. Patients who underwent SLNB had a significantly longer TTD for the BRAS dimension than those who underwent ALND. Cox multivariate analyses showed that treatment using SLNB and age >59 years were independently associated with longer TTD for the BRAS, whereas surgery elsewhere than at the Centre Georges François Leclerc was associated with a shorter TTD. CONCLUSION: Exploration of different definitions of TTD in QoL provides meaningful longitudinal QoL results for clinicians.

Population-based study of ovarian cancer in Côte d'Or: prognostic factors and trends in relative survival rates over the last 20 years.

BACKGROUND: The aim of this population-based study was to assess independent prognostic factors in ovarian cancer using relative survival (RS) and to investigate changes in RS rates from 1982 to 2005. METHODS: Data on 748 patients with ovarian cancer were provided by the Côte d'Or gynaecologic cancer registry. The RS was estimated using a generalized linear model with a Poisson error structure. Relative survival and its 95% confidence interval (CI) were described at the following specific time points 1, 3 and 5 years. The effect of prognostic factors on survival was assessed with multivariate analyses of RS. RESULTS: The median follow-up was 12 years. The RS rates at 1, 3 and 5 years were 81%, 55% and 44%, respectively. As compared with the period 1982-1989, an improvement in survival was found for the period 1998-2005: HR = 0.52[0.40-0.67]. Women who lived in urban areas had better RS: HR = 0.82[0.67-0.99]. Patients with epithelial types of ovarian cancer other than mucinous or endometrioid cancer had worse RS than those with serous histology. Age ≥ 70 years was associated with lower survival. CONCLUSIONS: Period of diagnosis, stage at diagnosis, histology, place of residence and age were independent prognostic factors for survival in ovarian cancer. An improvement in the survival rate was observed after 1998 but a significant improvement was limited to advanced stage cancers.