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Medline ® Abstract for Reference 14

of 'Overview of the treatment of newly diagnosed, non-metastatic breast cancer'

14
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Omission of surgery in elderly patients with early stage breast cancer.
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Hamaker ME, Bastiaannet E, Evers D, Water Wv, Smorenburg CH, Maartense E, Zeilemaker AM, Liefers GJ, Geest Lv, de Rooij SE, van Munster BC, Portielje JE
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Eur J Cancer. 2013;49(3):545.
 
AIM: To assess national trends over time in surgery for elderly patients with resectable breast cancer (BC) and to evaluate clinical outcome and cause of death after the omission of surgery in a regional cohort of elderly patients.
METHODS: National trends in 1995-2005 were calculated using cancer registry data. In addition, a chart review was performed in a cohort of patients aged⩾75years, with early stage BC but no primary surgery, diagnosed at five Dutch hospitals in 1990-2005. Patient characteristics, comorbidity and reason for the omission of surgery were collected from the chart. Cause of death was retrieved from death certificate data registered at Statistics Netherlands.
RESULTS: Omission of surgery increased significantly over time for patients aged 80years and older (p<0.05). Of the 187 patients in the regional cohort (median age 85.9years (range 75.0-97.7), 174 (92%) received hormonal therapy. Omission of surgery was at the patient's request in 59 patients (32%). Of the 178 patients that died during follow-up, 60 patients (34%) died of BC. For 81 patients (45%), BC was not clinically relevant at the time of death. Median overall survival was 2.3years (range 0.2-10.7) and did not differ between BC and other causes of death (p=0.9).
CONCLUSION: Omission of surgery for elderly patients with resectable BC has increased significantly over the past decade; instead patients often received primary endocrine treatment. Although this may appear an effective alternative to surgery, the potential for a longer term negative impact on disease control and quality of life deserves further investigation.
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Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands; Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: mhamaker@diakhuis.nl.
PMID