ArticleJournal of the National Cancer Institute2020
Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores.
Article in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices.The British journal of surgery · 2021Trial
- The population-level effects of omitting chemotherapy guided by a 21-gene expression assay in node-positive breast cancer: a simulation modeling study.BMC cancer · 2024Article
- Assessment High-Risk Breast Cancer in Older Patients: A Comparative Analysis of PREDICT Scores and TAILORx Risk Categorization.European journal of breast health · 2023Article
- The impact of chemotherapy and survival prediction by machine learning in early Elderly Triple Negative Breast Cancer (eTNBC): a population based study from the SEER database.BMC geriatrics · 2022Article
- Chronological age or biological age: What drives the choice of adjuvant treatment in elderly breast cancer patients?Translational oncology · 2022Article
- Article
- Reflecting on 20 years of breast cancer modeling in CISNET: Recommendations for future cancer systems modeling efforts.PLoS computational biology · 2021Review
- Trends in Breast Cancer Treatment De-Implementation in Older Patients with Hormone Receptor-Positive Breast Cancer: A Mixed Methods Study.Annals of surgical oncology · 2021Article
- Evaluating and Balancing the Risk of Breast Cancer-Specific Death and Other Cause-Specific Death in Elderly Breast Cancer Patients.Frontiers in oncology · 2021Article
- Chemotherapy and 21-gene recurrence score testing for older breast cancer patients: A competing-risks analysis.Breast (Edinburgh, Scotland) · 2020Article
- Patient Perspectives on Treatment Options for Older Women With Hormone Receptor-Positive Breast Cancer: A Qualitative Study.JAMA network open · 2020Article
- Adjuvant Chemotherapy for Older Patients With Breast Cancer: When Is the Pain Worth the Gain?Journal of the National Cancer Institute · 2020Article
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6 authors.
Funding
Abstract
backgroundTumor genomic expression profile data are used to guide chemotherapy choice, but there are gaps in evidence for women aged 65 years and older. We estimate chemotherapy effects by age and comorbidity level among women with early-stage, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers and Oncotype DX scores of 26 or higher.
methodsA discrete-time stochastic state transition simulation model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups based on age (65-69, 70-74, 75-79, and 80-89 years) and comorbidity levels (no or low, moderate, severe). Outcomes were discounted at 3%, and included quality-adjusted life-years (QALYs), life-years, and breast cancer and other-cause mortality with chemoendocrine vs endocrine therapy. Sensitivity analysis tested the effect of varying uncertain parameters.
resultsWomen aged 65-69 years with no or low comorbidity gained 0.16 QALYs with chemo-endocrine and reduced breast cancer mortality from 34.8% to 29.7%, for an absolute difference of 5.1%; this benefit was associated with a 12.8% rate of grade 3-4 toxicity. Women aged 65-69 years with no or low or moderate comorbidity levels, and women aged 70-74 years with no or low comorbidity had small chemotherapy benefits. All women aged 75 years and older experienced net losses in QALYs with chemo-endocrine therapy. The results were robust in sensitivity analyses. Chemotherapy had greater benefits as treatment effectiveness increased, but toxicity reduced the QALYs gained.
conclusionAmong women aged 65-89 years whose tumors indicate a high recurrence risk, only those aged 65-74 years with no or low or moderate comorbidity have small benefits from adding chemotherapy to endocrine therapy. Genomic expression profile testing (and chemotherapy use) should be reserved for women aged younger than 75 years without severe comorbidity.
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