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J Geriatr Oncol. 2018 May;9(3):214-220. doi: 10.1016/j.jgo.2017.11.004. Epub 2017 Nov 23.

Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer.

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Medical Oncology, Duke University Medical Center, Box 3204, Durham, NC 27710, USA. Electronic address:
Louisiana State University Health Sciences Center, 2020 Gravier Street, New Orleans, LA 70112, USA.
University of Kentucky College of Public Health, 1111 Washington Avenue, Lexington, KY 40536-0003, USA.
Division of Cancer Prevention and Control Centers for Disease Control and Prevention, 4770 Buford Highway MS K76, Atlanta, GA 30341, USA.
Department of Radiation Oncology, Medical College of Wisconsin, n8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Rm 720, Atlanta, GA 30322, USA.
Department of Public Health Sciences, UCDavis School of Medicine, Public Health Institute, Cancer Registry of Greater California, 1825 Bell St., Suite 102, Sacramento, CA 95825, USA.
Division of Health Services Research, Penn State College of Medicine, The UVA Cancer Center, PO Box 800717, Charlottesville, VA 22908-0793, USA.



To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death.


Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses.


Of 5852 patients, 76% were under 70years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p<0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR]=2.38, 95% CI 1.08-5.24), but not in younger patients (HR=1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR=2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR=3.79, 95% CI 1.72-8.33).


Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.


Adjuvant chemotherapy; Age; Breast cancer; Comorbidity; Risk–benefit; Survival


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