14 februari 2023: Raadpleeg ook de literatuurlijsten niet-toxische middelen en behandelingen van arts-bioloog drs. Engelbert Valstar specifiek bij borstkanker.

14 februari 2023: Bron: Epidemiology Published: 24 January 2023

Uit een retrospectief overzicht van de National Cancer Database (2010-2017) van de gegevens van 6827 vrouwen met borstkanker type ER positief, HER2 negatief en hoog risico op een recidief vanuit de resultaten van een 21 genentest (OncotypeDX) blijkt dat de weigering van chemotherapie bij oudere vrouwen (65-plus) te zorgen voor een mediaan mindere overall overleving in vergelijking met vrouwen die wel voor chemotherapie kozen.
De resultaten toonden aan dat het weigeren van chemotherapie geassocieerd was met mediaan mindere overlevingsresultaten bij vrouwen tussen 65 en 79 jaar van 65-74 jaar (92% vs 95%) en voor vrouwen in de leeftijd van 75-79 jaar (85% vs 92%) (p ≤ 0.05).
Maar er werd geen statistisch significant verschil in overall overleving gezien tussen patiënten ouder dan 80 jaar die chemotherapie weigerden en degenen die wel chemotherapie kregen, (84% versus 91%; p = 0,07).
Bij multivariabele analyse nam het risico op overlijden toe bij algehele weigering (HR 1,12, 95% BI 1,04-1,2); maar, gestratificeerd naar leeftijd, was niet verhoogd voor vrouwen ≥ 80 jaar (HR 1,10, 95% BI 0,80-1,51).

Je kunt je natuurlijk afvragen of je als vrouw in de leeftijd van 65 plus voor 3 tot maximaal 7 procent verschil in overall overleving op 5-jaars meting alle bijwerkingen van chemotherapie moet accepteren. Voor patiënten met borstkanker type ER positief, HER2 negatief zijn veel andere behandelingen mogelijk, hoewel ook die soms ernstige bijwerkingen geven.

Hier het abstract van deze studie waarvoor betaald moet worden om het volledige studierapport in te zien:

Chemotherapy refusal and subsequent survival in healthy older women with high genomic risk estrogen receptor-positive breast cancer

Breast Cancer Research and Treatment (2023)Cite this article

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Abstract

Background

Patients with estrogen receptor (ER)-positive, HER2-negative breast cancer (BC), and high-risk 21-gene recurrence score (RS) results benefit from chemotherapy. We evaluated chemotherapy refusal and survival in healthy older women with high-RS, ER-positive BC.

Methods

Retrospective review of the National Cancer Database (2010–2017) identified women ≥ 65 years of age, with ER-positive, HER2-negative, high-RS (≥ 26) BC. Patients with Charlson Comorbidity Index ≥ 1, stage III/IV disease, or incomplete data were excluded. Women were compared by chemotherapy receipt or refusal using the Cochrane–Armitage test, multivariable logistical regression modeling, the Kaplan–Meier method, and Cox’s proportional hazards modeling.

Results

6827 women met study criteria: 5449 (80%) received chemotherapy and 1378 (20%) refused. Compared to women who received chemotherapy, women who refused were older (71 vs 69 years), were diagnosed more recently (2014–2017, 67% vs 61%), and received radiation less frequently (67% vs 71%) (p ≤ 0.05). Refusal was associated with decreased 5-year OS for women 65–74 (92% vs 95%) and 75–79 (85% vs 92%) (p ≤ 0.05), but not for women ≥ 80 years old (84% vs 91%; p = 0.07). On multivariable analysis, hazard of death increased with refusal overall (HR 1.12, 95% CI 1.04–1.2); but, when stratified by age, was not increased for women ≥ 80 years (HR 1.10, 95% CI 0.80–1.51).

Conclusions

Among healthy women with high-RS, ER-positive BC, chemotherapy refusal was associated with decreased OS for women ages 65–79, but did not impact the OS of women ≥ 80 years old. Genomic testing may have limited utility in this population, warranting prudent shared decision-making and further study.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the data use agreement with the National Cancer Database, which restricts access to the dataset to hospitals that contribute to the NCDB. Data are available from the corresponding author on reasonable request.

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