PURPOSE: Although it is widely accepted that hormone receptor (HR) status is associated with later post-diagnostic periods, a debate exists as to whether the association is independent of age. The aim of our study was to confirm the impact of HR status on later period breast cancer-specific death (LP-BCSD) and later period non-breast cancer-specific death (LP-non-BCSD) in different age subgroups. METHODS: Surveillance, Epidemiology, and End Results databases were utilized to identify 181,108 breast cancer patients with > 5 years survival. The cumulative incidence of LP-BCSD and LP-non-BCSD was calculated using the Gray method. The subdistribution hazard ratio (SHR) of variables was estimated via the Fine and Gray proportional hazard regression model. Subgroup analyses for LP-BCSD and LP-non-BCSD were performed according to the HR status. RESULTS: The risk of LP-BCSD was exceeded by that of LP-non-BCSD at > 5 years since the diagnosis, particularly in old women. The competing risk regression model indicated that hormone receptor-positive (HR+) was an independent factor for more LP-BCSD (hazard ratio, 1.54; 95% confidence interval, 1.44–1.54; p < 0.001). However, stratified analysis indicated that HR+ was only associated with more LP-BCSD in the young women subgroup. Although HR+ was associated with more LP-non-BCSD, the predictive value of HR+ for LP-non-BCSD was eliminated after adjusting for age. CONCLUSIONS: HR+ was related to LP-BCSD in the premenopausal population. LP-BCSD should be an optimal endpoint in future trials designed to evaluate the role of extended adjuvant endocrine therapy.
Breast Neoplasms ; Breast ; Diagnosis ; Drug Therapy ; Epidemiology ; Female ; Humans ; Incidence ; Methods ; Prognosis ; Receptors, Estrogen

Breast cancer is the most common malignant tumor among women all over the world. In 2015, there were about 304, 000 new cases of breast cancer in Chinese female, with more than 70, 000 deaths. Of the new cases of breast cancer each year, about 3% to 10% of patients have distant metastasis at the time of diagnosis. Of the early-stage patients, about 30% developed into advanced breast cancer. The 5-years survival rate of advanced breast cancer was only 20%, and the median overall survival time was 2-3 years. Although advanced breast cancer is difficult to cure at present, we can alleviate the clinical symptoms of patients, improve their quality of life and further prolong their survival time by developing new therapeutic drugs and optimizing treatment models, to achieve the purpose of long-term survival with tumor. It is very important for patients with advanced breast cancer to choose the reasonable treatment plan. Since there is lack of standard recommendation for the treatment of advanced breast cancer after the first and second line chemotherapy, according to the research progress of breast cancer at home and abroad and the update of real-world clinical research data, the Chinese expert group analyzed, summarized and discussed the relevant research data, updated the diagnosis, treatment and prognosis of inoperable locally advanced and recurrent or metastatic breast cancer on the basis of version 2018, and formulated the "Guidelines for clinical diagnosis and treatment of advanced breast cancer in China (2020 Edition)" (ABCC 2020) for clinicians' reference.
Breast Neoplasms/drug therapy* ; China/epidemiology* ; Female ; Humans ; Practice Guidelines as Topic ; Prognosis ; Quality of Life ; Survival Rate

Breast cancer is the most common malignant tumor among women all over the world. In 2020, there were about 416 000 new cases, and more than 117 000 deaths of breast cancer in Chinese female. Of the new cases of breast cancer each year, about 3% to 10% of patients have distant metastasis at the time of diagnosis. Of the early-stage patients, about 30% developed into advanced breast cancer. The 5-year survival rate of advanced breast cancer was only 20%, and the median overall survival was 2-3 years. Although advanced breast cancer is difficult to cure at present, we can alleviate the clinical symptoms of patients, improve their quality of life and further prolong their survival time by applying new therapeutic drugs and optimizing treatment models, to achieve the purpose of long-term survival with tumor. It is very important for patients with advanced breast cancer to choose the reasonable treatment plan, and because of the lack of standard recommendation for the treatment of advanced breast cancer after the first- and second-line rescue therapies, according to the research progress of breast cancer at home and abroad and the update of real-world clinical data, the Chinese expert group analyzed, discussed and summarized the relevant research data, updated the diagnosis, treatment and prognosis of inoperable locally advanced and recurrent or metastatic breast cancer on the basis of the 2020 edition, and formulated the "Guidelines for clinical diagnosis and treatment of advanced breast cancer in China (2022 edition)" for clinicians' reference.
Female ; Humans ; Breast Neoplasms/drug therapy* ; Quality of Life ; Prognosis ; China/epidemiology*

OBJECTIVEThis study was conducted to investigate the correlation between anemia and postoperative chemotherapy in elderly cancer patients.

METHODSOne hundred and fifty-seven elderly patients ( age ≥ 60) with pathologically confirmed breast, lung and digestive tract cancers, who had HGB ≥ 120 g/L and ECOG scores 0-2, were included in this study. We reviewed their clinicopathological data and analyzed the correlation of anemia in breast cancer patients after 1, 3 or 5 cycles and lung cancer patients after 1, 2 or 3 cycles of postoperative chemotherapy.

RESULTSAmong the 157 cases, the overall proportion of anemia was 31.8% (50/157) , with 18.8% in male and 47.2% in female patients (P < 0.001). After three cycles of chemotherapy, the proportion of anemia was 57.9% in lung cancer, 34.5% in breast cancer, 26.3% in gastric cancer and 9.3% in colorectal cancer patients (P < 0.001). The proportion of anemia during 5 cycles chemotherapy (three cycles in lung cancer) was gradually increasing. In the lung cancer patients, anemia was observed in 66.7% of patients who received vinorelbine plus cispiatin regimen and 25.0% of cases who received vinorelbine regimen chemotherapy (P = 0.044).

CONCLUSIONSIn most elderly patients with normal hemoglobin level and in good conditions, the chemotherapy-related anemia is mild and less frequent. Age should not limit the adjuvant chemotherapy in elderly cancer patients. Attention should be paid to the possibility of anemia in elderly female lung cancer patients receiving multiple cycle platinum-based chemotherapy regimens.

Aged ; Anemia ; chemically induced ; epidemiology ; Antineoplastic Agents ; adverse effects ; Breast Neoplasms ; drug therapy ; Chemotherapy, Adjuvant ; Cisplatin ; adverse effects ; Colorectal Neoplasms ; drug therapy ; Female ; Humans ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged ; Stomach Neoplasms ; drug therapy ; Vinblastine ; adverse effects ; analogs & derivatives

PURPOSE: The goal of this registry was to collect patient characteristics and safety data from patients from the Asia-Pacific region with early breast cancer receiving adjuvant chemotherapy containing docetaxel (Taxotere(R)). METHODS: This registry was open-label, international, longitudinal, multicenter, and observational in design and included a prospective group of consecutive early breast cancer patients with an intermediate-to-high risk of recurrence being treated with various docetaxel-based (anthracycline and non-anthracycline) adjuvant chemotherapy regimens during 2009-2013 in real-world clinical settings. RESULTS: The analysis included 1,712 patients, 79% of whom received docetaxel-based, anthracycline-containing regimens, while 21% received non-anthracycline-containing regimens. Patients receiving adjuvant docetaxel-based chemotherapy were followed for 1.5 years. Chemotherapy-related adverse events (AEs) were reported by 76.2% of patients (anthracycline-containing vs. non-anthracycline-containing regimens: 76.8% vs. 74.1%). Serious AEs were reported in 12% of patients (12.3% vs. 10%). National Cancer Institute Common Terminology Criteria for Adverse Events grade 3 or higher neutropenia was reported in 20% of patients (21.6% vs. 13.9%), leukopenia in 7.4% of patients (5.4% vs. 14.8%), and vomiting in 1.6% of patients (1.8% vs. 0.6%). Treatment-related death was reported in 27 patients (1.6%), while only 3% of patients had a relapse. Low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (HDL-C) and total cholesterol/HDL-C ratios increased after chemotherapy. A clinically insignificant reduction of 1.9% in left ventricular ejection fraction, from 66.43 to 64.53, was observed 1.5 years after therapy was completed. CONCLUSION: The Asia-Pacific Breast initiative II registry identified a variety of important facts regarding patient population characteristics, disease epidemiology and treatment response for early breast cancer patients of the Asia-Pacific region receiving docetaxel-based chemotherapy. Docetaxel-based chemotherapy did not show any significant safety concerns for early breast cancer patients of the Asia-Pacific region, and thus may represent a safe adjuvant chemotherapy regimen for these patients.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cholesterol ; Drug Therapy* ; Epidemiology ; Humans ; Leukopenia ; Lipoproteins ; National Cancer Institute (U.S.) ; Neutropenia ; Population Characteristics ; Prospective Studies ; Recurrence ; Registries ; Stroke Volume ; Vomiting

PURPOSE: Cardiotoxicity following cancer chemotherapy or radiotherapy is an emerging issue for breast cancer patients. The purpose of this study was to analyze the current domestic research trends for exercise intervention for Korean breast cancer patients under chemotherapy or radiotherapy, focused on cardiovascular indices as study outcome measures and to make suggestions for future nursing studies. METHODS: A literature search was done using PubMed, CINAHL and two Korean databases to identify experimental studies reported in Korean or English between 2,000 and 2015. We identified five studies independently reviewed by two reviewers. The quality and risk of bias of the selected studies were assessed by RoBANS criteria. RESULTS: Tai-chi exercise was used in three studies and aerobic exercise programs or yoga and walking exercise in the remaining studies. Two studies evaluated cardiovascular outcomes and showed positive findings for breast cancer patients. For cardiovascular indices, heart rate and blood pressure were used. CONCLUSION: This study showed the need for conducting well-designed experimental studies including clinical cardiovascular outcomes to generate evidence on exercise intervention for cancer therapy-induced cardiotoxicity prevention. Additional studies are warranted to accelerate the potential use of exercise as a nursing intervention for cancer patients under chemotherapy or radiotherapy.
Bias (Epidemiology) ; Blood Pressure ; Breast Neoplasms* ; Breast* ; Cardiovascular System ; Drug Therapy* ; Exercise ; Heart Rate ; Humans ; Nursing ; Outcome Assessment (Health Care) ; Radiotherapy* ; Walking ; Yoga

BACKGROUND: Tamoxifen is one of the most widely prescribed drug in patients with breast cancer and has been proven to have a favorable effect on disease-free survival (DFS) and overall survival (OS) when given as an adjuvant therapy. However, there is little known about the effects of tamoxifen in Korean patients with breast cancer. The purpose of this report was to obtain the informations about tamoxifen as an adjuvant therapy for the prospective study hereafter. METHODS: The medical records of 349 patients with breast cancer from Jan. 1 1988 to Dec. 31 1995, who have no distant metastasis and have had adjuvant therapies after surgery with appropriate follow up, were reviewed retrospectively. The univariate analysis of various prognostic factors, such as age, menopausal status, stage, steroid receptor status, operation method, chemotherapy, and the relationship of tamoxifen therapy with them were analyzed using SAS program. RESULTS: 1) The benefit of Tamoxifen administration in DFS was observed in women 40-49 and over 60 years of age, premenopausal women, tumors with the size of 2-5 cm, Stage IIb, progesterone receptor positive tumors, and for patients treated with chemotherapy and CAF (Cyclophopamide Adriamycin 5-Fluorouracil) regimen of it. Tamoxifen also improved OS in women over 60 years of age, Stage I or IIb, and for the patients treated with chemotherapy and CAF regimen (P<0.05, log rank or Wilcoxon test). 2) The relapse or death rate decreased linearly as the duration of tamoxifen administration was extended (P=0.001, Cochran-Armitage test). The Kaplan-Meier disease free and overall survival rates of the four groups of duration were significantly different (P=0.0001, logrank test). CONCLUSIONS: There is a benefit of tamoxifen therapy in the patients aged 60 or older, tumors with the size of 5 cm or less, Stage IIb or less, and for the patients treated with chemotherapy and CAF regimen of it. This benefit is increasing as the duration of tamoxifen administration is extended. Thebenefit of tamoxifen is unreliable in the patients aged 40-49, premenopausal women and progesterone receptor positive tumors, possibly because of bias in those subsets.
Bias (Epidemiology) ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Mortality ; Neoplasm Metastasis ; Receptors, Progesterone ; Receptors, Steroid ; Recurrence ; Retrospective Studies ; Survival Rate ; Tamoxifen*

BACKGROUND: The National Health Insurance Service (NHIS) established a healthcare claim database for all Korean citizens. This study aimed to analyze the NHIS data and investigate the patterns of breast cancer treatments. METHODS: We constructed a retrospective female breast cancer cohort by analyzing annual incident cases. The annual number of newly diagnosed female breast cancer was compared between the NHIS data and Korea National Cancer Incidence Database (KNCIDB). The annual treatment patterns including surgery, chemotherapy, radiation therapy, endocrine therapy and targeted therapy were analyzed. RESULTS: A total of 148,322 women with newly diagnosed invasive breast cancer during 2006–2014 was identified. The numbers of newly diagnosed invasive breast cancer cases were similar between the NHIS data and KNCIDB, which demonstrated a strong correlation (r = 0.995; P < 0.001). The age distribution of the breast cancer cases in the NHIS data and KNCIDB also showed a strong correlation (r = 1.000; P < 0.001). About 85% of newly diagnosed breast cancer patients underwent operations. Although the proportions of chemotherapy use have not changed during 2006–2014, the total number of chemotherapy prescriptions sharply increased during this period. The proportions of radiotherapy and anti-hormonal therapy increased. Among the anti-hormonal agents, tamoxifen was the most frequently prescribed medication, and letrozole was the most preferred endocrine treatment in patients aged ≥ 50 years. CONCLUSION: Along with the increased breast cancer incidence in Korea, the frequencies of breast cancer treatments have increased. The NHIS data can be a feasible data source for future research.
Age Distribution ; Breast Neoplasms* ; Breast* ; Cohort Studies ; Delivery of Health Care ; Drug Therapy ; Epidemiology ; Female ; Humans ; Incidence ; Information Storage and Retrieval ; Korea ; National Health Programs* ; Prescriptions ; Radiotherapy ; Retrospective Studies ; Survivors* ; Tamoxifen

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages. There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representation of such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positive disease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis, under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advanced breast cancer should be treated based on their biological tumor type, according to the patient's general health and preferences: endocrine treatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrine therapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who are HR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequential chemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patients are recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessment should be performed for older patients to assess the patients' biological age, functional status, and address age-specific problems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, and independence of older patients with cancer.
Aged ; Bias (Epidemiology) ; Breast Neoplasms* ; Delayed Diagnosis ; Delivery of Health Care ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Early Intervention (Education) ; Geriatric Assessment ; Humans ; Incidence ; Life Expectancy ; Mortality ; Quality of Life ; Receptor, Epidermal Growth Factor ; Capecitabine

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages. There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representation of such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positive disease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis, under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advanced breast cancer should be treated based on their biological tumor type, according to the patient's general health and preferences: endocrine treatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrine therapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who are HR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequential chemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patients are recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessment should be performed for older patients to assess the patients' biological age, functional status, and address age-specific problems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, and independence of older patients with cancer.
Aged ; Bias (Epidemiology) ; Breast Neoplasms* ; Delayed Diagnosis ; Delivery of Health Care ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Early Intervention (Education) ; Geriatric Assessment ; Humans ; Incidence ; Life Expectancy ; Mortality ; Quality of Life ; Receptor, Epidermal Growth Factor ; Capecitabine