Evidence map›Paper›PMID 37851196›Full record

ArticleAnnals of surgical oncology2024

Trends in Locoregional Therapy in Older Women with Early-Stage Hormone Receptor-Positive Breast Cancer by Frailty and Life Expectancy.

Christina A Minami, Ginger Jin, Rachel A Freedman, Mara A Schonberg, Tari A King, Elizabeth A Mittendorf

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06896474 (SDM POSSIBLE), which is not on this map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06896474 narecruitingnot on this mapstarted 2026, after this paper: background citation

SDM POSSIBLE: A Cluster RCT of a Breast Cancer Treatment Decision Aid for Women 70+ With Low-Risk Stage I Breast Cancers

TypeinterventionalSponsorBeth Israel Deaconess Medical CenterRan2026 to 2033Enrolled402ConditionsBreast CancerArmsShared Decision-Making Training and Decision Aid
3 · Its place in the literature

Who cites it

11 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Christina A MinamiDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. cminami@mgb.org.
Ginger JinCenter for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Rachel A FreedmanBreast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Mara A SchonbergHarvard Medical School, Boston, MA, USA.
Tari A KingDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Elizabeth A MittendorfDivision of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.

Funding

Research and mentoring program in shared decision making in the care of older adultsK24AG071906 · NIA · BETH ISRAEL DEACONESS MEDICAL CENTER · PI SCHONBERG, MARA A · 2021 to 2025
$946k
Locoregional Treatment Decision-making in Older Adults with Early-Stage, Hormone Receptor-Positive Breast CancerR03AG073986 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI MINAMI, CHRISTINA A · 2021 to 2022
$258k
NCI NIH HHS HHSN261201800009CNCI NIH HHS HHSN261201800009INCI NIH HHS HHSN261201800015CNCI NIH HHS HHSN261201800015INCI NIH HHS HHSN261201800032CNCI NIH HHS HHSN261201800032INIA NIH HHS K24 AG071906NIA NIH HHS R03 AG073986NIH HHS 5K24AG071906
6 · The paper itself

Abstract

backgroundIn women ≥ 70 years of age with T1N0 hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer, breast surgery type and omission of axillary surgery or radiation therapy (RT) do not impact overall survival. Although frailty and life expectancy ideally factor into therapy decisions, their impact on therapy receipt is unclear. We sought to identify trends in and factors associated with locoregional therapy type by frailty and life expectancy.

methodsWomen ≥ 70 years of age with T1N0 HR+/HER2- breast cancer diagnosed in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 2010 and 2015 were stratified by validated claims-based frailty and life expectancy measures. Therapy trends over time by regimen intensity ('high intensity': lumpectomy + axillary surgery + RT, or mastectomy + axillary surgery; 'moderate intensity': lumpectomy + RT, lumpectomy + axillary surgery, or mastectomy only; or 'low intensity': lumpectomy only) were analyzed. Factors associated with therapy type were identified using generalized linear mixed models.

resultsOf 16,188 women, 21.8% were frail, 22.2% had a life expectancy < 5 years, and only 12.3% fulfilled both criteria. In frail women with a life expectancy < 5 years, high-intensity regimens decreased significantly (48.8-31.2%; p < 0.001) over the study period, although in 2015, 30% still received a high-intensity regimen. In adjusted analyses, frailty and life expectancy < 5 years were not associated with breast surgery type but were associated with a lower likelihood of axillary surgery (frailty: odds ratio [OR] 0.86, 95% confidence interval [CI] 0.76-0.96; life expectancy < 5 years: OR 0.22, 95% CI 0.20-0.25). Life expectancy < 5 years was also associated with a lower likelihood of RT receipt in breast-conserving surgery patients (OR 0.30, 95% CI 0.27-0.34).

conclusionsRates of high-intensity therapy are decreasing but overtreatment persists in this population. Continued efforts aimed at appropriate de-escalation of locoregional therapy are needed.

Indexed as

Breast NeoplasmsFrailtyAgedFemaleHumansMastectomyMastectomy, SegmentalMedicareNeoplasm StagingUnited StatesBreast cancerFrailtyGeriatric oncologyLife expectancyLocoregional therapyRadiationSurgery

Identifiers

PMID37851196
PMCPMC10826462

What OpenQuestion holds

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LicenceTDM
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.