nach oben

Breast Cancer Research and Treatment

Erschienen in:

24.09.2020 | Epidemiology

Impact of patients’ refusal to undergo adjuvant treatment measures on survival

verfasst von: H. Männle, J. W. Siebers, F. Momm, K. Münstedt

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients’ refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany.

Methods

A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan–Meier survival analyses, and Cox regression analyses regarding the effects of their refusal.

Results

About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ² = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ²_radiotherapy = 109.1; df = 1; p < 0.001, χ²_chemotherapy = 18.3; df = 1; p < 0.001, χ²_endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ²_radiotherapy = 184.9; df = 6; p < 0.001; χ²_chemotherapy = 191.8; df = 6; p < 0.001).

Conclusions

All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients’ refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716. https://doi.org/10.1016/S0140-6736(11)61629-2CrossRef

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S, McGale P, Pan HC, Taylor C, Wang YC, Dowsett M, Ingle J, Peto R (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378(9793):771–784. https://doi.org/10.1016/S0140-6736(11)60993-8CrossRef

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J, Gray R, Pan HC, Clarke M, Cutter D, Darby S, McGale P, Taylor C, Wang YC, Bergh J, Di Leo A, Albain K, Swain S, Piccart M, Pritchard K (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379(9814):432–444. https://doi.org/10.1016/S0140-6736(11)61625-5CrossRef

Early Breast Cancer Trialists' Collaborative Group (EBCTCG), McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, Gray R, Mannu G, Peto R, Whelan T, Wang Y, Wang Z, Darby S (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383(9935):2127–2135. https://doi.org/10.1016/S0140-6736(14)60488-8CrossRef

Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2018) Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 19(1):27–39. https://doi.org/10.1016/S1470-2045(17)30777-5CrossRef

Keating NL, Landrum MB, Lamont EB, Bozeman SR, Shulman LN, McNeil BJ (2013) Tumor boards and the quality of cancer care. J Natl Cancer Inst 105(2):113–121. https://doi.org/10.1093/jnci/djs502CrossRefPubMedPubMedCentral

Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N (2018) The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board. Ann Surg Oncol 25(10):2953–2957. https://doi.org/10.1245/s10434-018-6599-yCrossRefPubMedPubMedCentral

Marcinkowski EF, Ottesen R, Niland J, Vito C (2017) Acceptance of adjuvant chemotherapy recommendations in early-stage hormone-positive breast cancer. J Surg Res 214:79–85. https://doi.org/10.1016/j.jss.2017.02.035CrossRefPubMed

Ma AM, Barone J, Wallis AE, Wu NJ, Garcia LB, Estabrook A, Rosenbaum-Smith SM, Tartter PI (2008) Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients. Am J Surg 196(4):500–504. https://doi.org/10.1016/j.amjsurg.2008.06.027CrossRefPubMed

10.

Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol 28(27):4120–4128. https://doi.org/10.1200/JCO.2009.25.9655CrossRefPubMedPubMedCentral

11.

Calip GS, Xing S, Jun DH, Lee WJ, Hoskins KF, Ko NY (2017) Polypharmacy and adherence to adjuvant endocrine therapy for breast cancer. J Oncol Pract 13(5):e451–e462. https://doi.org/10.1200/JOP.2016.018317CrossRefPubMed

12.

Mausbach BT, Schwab RB, Irwin SA (2015) Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 152(2):239–246. https://doi.org/10.1007/s10549-015-3471-7CrossRefPubMedPubMedCentral

13.

Neugut AI, Hillyer GC, Kushi LH, Lamerato L, Buono DL, Nathanson SD, Bovbjerg DH, Mandelblatt JS, Tsai WY, Jacobson JS, Hershman DL (2016) A prospective cohort study of early discontinuation of adjuvant chemotherapy in women with breast cancer: the breast cancer quality of care study (BQUAL). Breast Cancer Res Treat 158(1):127–138. https://doi.org/10.1007/s10549-016-3855-3CrossRefPubMedPubMedCentral

14.

Wulaningsih W, Garmo H, Ahlgren J, Holmberg L, Folkvaljon Y, Wigertz A, Van Hemelrijck M, Lambe M (2018) Determinants of non-adherence to adjuvant endocrine treatment in women with breast cancer: the role of comorbidity. Breast Cancer Res Treat 172(1):167–177. https://doi.org/10.1007/s10549-018-4890-zCrossRefPubMedPubMedCentral

15.

Chéreau E, Coutant C, Gligorov J, Lesieur B, Antoine M, Daraï E, Uzan S, Rouzier R (2011) Discordance with local guidelines for adjuvant chemotherapy in breast cancer: reasons and effect on survival. Clin Breast Cancer 11(1):46–51. https://doi.org/10.3816/CBC.2011.n.008CrossRefPubMed

16.

Joseph K, Vrouwe S, Kamruzzaman A, Balbaid A, Fenton D, Berendt R, Yu E, Tai P (2012) Outcome analysis of breast cancer patients who declined evidence-based treatment. World J Surg Oncol 10:118. https://doi.org/10.1186/1477-7819-10-118CrossRefPubMedPubMedCentral

17.

Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134(2):459–478. https://doi.org/10.1007/s10549-012-2114-5CrossRefPubMedPubMedCentral

18.

Huiart L, Ferdynus C, Giorgi R (2013) A meta-regression analysis of the available data on adherence to adjuvant hormonal therapy in breast cancer: summarizing the data for clinicians. Breast Cancer Res Treat 138(1):325–328. https://doi.org/10.1007/s10549-013-2422-4CrossRefPubMed

19.

Lambert-Côté L, Bouhnik AD, Bendiane MK, Bérenger C, Mondor M, Huiart L, Lauzier S (2020) Adherence trajectories of adjuvant endocrine therapy in the five years after its initiation among women with non-metastatic breast cancer: a cohort study using administrative databases. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-020-05549-xCrossRefPubMed

20.

Lambert LK, Balneaves LG, Howard AF, Gotay CC (2018) Patient-reported factors associated with adherence to adjuvant endocrine therapy after breast cancer: an integrative review. Breast Cancer Res Treat 167(3):615–633. https://doi.org/10.1007/s10549-017-4561-5CrossRefPubMed

21.

Johnson SB, Park HS, Gross CP, Yu JB (2018) Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djx145CrossRefPubMedPubMedCentral

22.

Medicine C (2018) Refusal of conventional cancer therapy, and survival among patients with curable cancers. JAMA Oncol 4(10):1375–1381. https://doi.org/10.1001/jamaoncol.2018.2487CrossRef

Titel: Impact of patients’ refusal to undergo adjuvant treatment measures on survival
verfasst von: H. Männle
J. W. Siebers
F. Momm
K. Münstedt
Publikationsdatum: 24.09.2020
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 1/2021
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05939-1

Springer Medizin

Impact of patients’ refusal to undergo adjuvant treatment measures on survival

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2021

A dynamic portrait of adverse events for breast cancer patients: results from a phase II clinical trial of eribulin in advanced HER2-negative breast cancer

Impact of adjuvant chemotherapy or tamoxifen-alone on the ovarian reserve of young women with breast cancer

Incidence and survival of inflammatory breast cancer between 1973 and 2015 in the SEER database

Long-term survival outcomes of repeat lumpectomy for ipsilateral breast tumor recurrence: a propensity score-matched analysis

The prognostic and predictive role of the neutrophil-to-lymphocyte ratio and the monocyte-to-lymphocyte ratio in early breast cancer, especially in the HER2+ subtype

Serial single-cell profiling analysis of metastatic TNBC during Nab-paclitaxel and pembrolizumab treatment

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie