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Use and Outcomes of Adjuvant Chemotherapy in Older Women With Breast Cancer

Sharon H. Giordano, Zhigang Duan, Yong-Fang Kuo, Gabriel N. Hortobagyi, James S. Goodwin

From the Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston; and the Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX

Address reprint requests to Sharon H. Giordano, MD, MPH, M.D. Anderson Cancer Center, PO Box 301439, Unit 1354, Houston, TX 77230; e-mail: sgiordan{at}mdanderson.org

PURPOSE: This study was undertaken to determine patterns and outcomes of adjuvant chemotherapy use in a population-based cohort of older women with primary breast cancer.

PATIENTS AND METHODS: Women were identified from the Surveillance, Epidemiology, and End Results–Medicare-linked database who met the following criteria: age 65 years, stage I to III breast cancer, and diagnosis between 1991 and 1999. Adjuvant chemotherapy use was ascertained by Common Procedural Terminology J codes. Logistic regression analysis was performed to determine factors associated with chemotherapy use. Multivariate Cox proportional hazards models were used to calculate the hazard of death for women with and without chemotherapy.

RESULTS: A total of 41,390 women met study criteria, of whom 4,500 (10.9%) received chemotherapy. The use of adjuvant chemotherapy more than doubled during the 1990s, from 7.4% in 1991 to 16.3% in 1999 (P < .0001), with a significant shift toward anthracycline use. Women who were younger, white, with lower comorbidity scores, more advanced stage disease, and estrogen receptor (ER) –negative disease were significantly more likely to receive chemotherapy. Chemotherapy was not associated with improved survival among women with lymph node–negative (LN) disease or LN-positive, ER-positive disease (hazard ratio [HR], 1.05; 95% CI, 0.85 to 1.31). However, among women with LN-positive, ER-negative breast cancer, chemotherapy was associated with a significant reduction in breast cancer mortality (HR, 0.72; 95% CI, 0.54 to 0.96). A similar significant benefit of chemotherapy was seen in the subset of women age 70 years or older (HR, 0.74; 95% CI, 0.56 to 0.97).

CONCLUSION: In this observational cohort, chemotherapy was associated with a significant reduction in mortality among older women with ER-negative, LN-positive breast cancer.

Supported in part by National Institutes of Health Grant No. 1K07 CA 109064-01 (to S.H.G) and the Center on Population Health and Health Disparities Grant No. P50CA105631.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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