Regional Variation in Deescalated Therapy in Older Adults With Early-Stage Breast Cancer Article Swipe
Christina A. Minami
,
Tanujit Dey
,
Yu-Jen Chen
,
Rachel A. Freedman
,
Eliza H. Lorentzen
,
Tari A. King
,
Elizabeth A. Mittendorf
,
Mara A. Schonberg
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.41152
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.41152
Importance Although trial data support the omission of axillary surgery and radiation therapy (RT) in women aged 70 years or older with T1N0 hormone receptor–positive (HR + ) breast cancer, potential overtreatment in older adults with frailty persists. Objective To determine how much geospatial variation in locoregional therapy may be attributed to region vs patient factors. Design, Setting, and Participants This retrospective cross-sectional study included women aged 70 years or older who were diagnosed with HR + /ERBB2-negative (ERBB2 − ) breast cancer from January 1, 2013, to December 31, 2017. Data came from Surveillance, Epidemiology, and End Results–Medicare. Hierarchical multivariable modeling was used to evaluate the variance in deescalated care attributable to 4 domains, ie, (1) random, (2) region (health service area [HSA]), (3) patient factors, and (4) unexplained. Patient factors included age, frailty (validated claims-based measure), Charlson Comorbidity Index (CCI), and socioeconomic status (Yost index). Analyses were performed from January to October 2023. Exposure HSA. Main Outcomes and Measures Deescalated care, defined as omission of axillary surgery, RT, or both. Standard therapy was defined as lumpectomy, axillary surgery, and RT or mastectomy with axillary surgery. Multivariable logistic regression was used to identify factors associated with deescalated care receipt. Results Of 9173 patients (mean [SD] age, 76.5 [5.2] years), 2363 (25.8%) were aged 80 years or older, 705 (7.7%) had frailty, and 419 (4.6%) had a CCI of 2 or greater. While 4499 (49.1%) underwent standard therapy, 4674 (50.9%) underwent deescalated therapy (1193 [13.0%] of the population omitted axillary surgery and 4342 [55.5%] of patients undergoing lumpectomy omitted RT). Of the total variance, random variation explained 27.3%, region/HSA explained 35.3%, patient factors explained 2.8%, and 34.5% was unexplained. In adjusted models, frailty and increased age were associated with a higher likelihood of undergoing deescalated therapy (frailty: odds ratio [OR], 1.70; 95% CI, 1.43-2.02; age, by 1-year increment: OR, 1.10; 95% CI, 1.09-1.11), but CCI was not. Patients in rural areas compared with those in urban areas (OR, 0.82; 95% CI, 0.68-0.99) and Asian and Pacific Islander patients compared with non-Hispanic White patients (OR, 0.68; 95% CI, 0.54-0.85) had a lower likelihood of undergoing deescalated therapy. Conclusions and Relevance In this retrospective cross-sectional study of women aged 70 years or older diagnosed with T1N0 HR + /ERBB2 − breast cancer, region/HSA contributed more to the variation in deescalated therapy use than patient factors. Unexplained variation may be attributed to unmeasured characteristics, such as multidisciplinary environment and patient preference. Decision support efforts to address overtreatment should target regions with low rates of evidence-based deescalation.
Related Topics
Concepts
Medicine
Breast cancer
Lumpectomy
Mastectomy
Population
Cancer registry
Internal medicine
Logistic regression
Breast-conserving surgery
Comorbidity
Retrospective cohort study
Epidemiology
Cancer
Environmental health
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2024.41152
- OA Status
- gold
- Cited By
- 2
- References
- 50
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4403728850
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4403728850Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1001/jamanetworkopen.2024.41152Digital Object Identifier
- Title
-
Regional Variation in Deescalated Therapy in Older Adults With Early-Stage Breast CancerWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-10-24Full publication date if available
- Authors
-
Christina A. Minami, Tanujit Dey, Yu-Jen Chen, Rachel A. Freedman, Eliza H. Lorentzen, Tari A. King, Elizabeth A. Mittendorf, Mara A. SchonbergList of authors in order
- Landing page
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https://doi.org/10.1001/jamanetworkopen.2024.41152Publisher landing page
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1001/jamanetworkopen.2024.41152Direct OA link when available
- Concepts
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Medicine, Breast cancer, Lumpectomy, Mastectomy, Population, Cancer registry, Internal medicine, Logistic regression, Breast-conserving surgery, Comorbidity, Retrospective cohort study, Epidemiology, Cancer, Environmental healthTop concepts (fields/topics) attached by OpenAlex
- Cited by
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2Total citation count in OpenAlex
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2025: 2Per-year citation counts (last 5 years)
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10Other works algorithmically related by OpenAlex
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| primary_location.landing_page_url | https://doi.org/10.1001/jamanetworkopen.2024.41152 |
| publication_date | 2024-10-24 |
| publication_year | 2024 |
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