Underuse, Misuse of Adjuvant Endocrine Therapy for Breast Cancer Has Decreased

Although beneficial, adjuvant endocrine therapy is not received by many patients for which it would be suitable.
Although beneficial, adjuvant endocrine therapy is not received by many patients for which it would be suitable.

Albeit underuse and misuse of adjuvant endocrine therapy for breast cancer has decreased since 2004, significant variation in care persists, according to a study published in JAMA Oncology.1

Multiple clinical trials have shown the clinical advantages of adjuvant endocrine therapy in terms of improving disease-free and overall survival; however, the concordance with adjuvant endocrine therapy guidelines as a measure of quality of care remains unclear.

To investigate temporal trends in, and factors associated with, receipt of adjuvant endocrine therapy for stage I to III breast cancer, researchers retrospectively analyzed data from 981,729 women with breast cancer included in the National Cancer Database from 2004 through 2013. Of those, 818,435 patients had hormone receptor (HR)-positive cancer and 163,294 had HR-negative tumors.

Among patients with HR-positive breast cancer, results showed that receipt of adjuvant endocrine therapy increased from 69.8% in 2004 to 82.4% in 2013, whereas receipt declined from 5.2% to 3.4% among women with HR-negative cancer.

Investigators found that hospital-level adherence, defined as 80% of patients or more with HR-positive cancer receiving adjuvant endocrine therapy, rose from 40.2% in 2004 to 69.2% in 2013, with receipt of therapy varying significantly by age, race, geographic location, and receptor status.

Specifically, patients aged 80 years or older; African American and Hispanic patients; patients residing in the West South Central, Mountain, and Pacific census regions; and patients with estrogen receptor̶negative and progesterone receptor̶positive cancer were significantly less likely to receive adjuvant endocrine therapy.

The involvement of surgery and radiotherapy were the factors most significantly associated with optimal use, highlighting the benefits of team-based care to support guideline-concordant therapy.

Because receipt of adjuvant endocrine therapy was associated with 29% reduced risk of death, 14,630 lives could have been saved over the 10-year period had all patients with HR-positive disease received postoperative endocrine therapy.

Reference

1. Daly B, Olopade OI, Hou N, et al. Evaluation of the quality of adjuvant endocrine therapy delivery for breast cancer care in the United States. JAMA Oncol. 2017 Feb 2. doi: 10.1001/jamaoncol.2016.6380 [Epub ahead of print]

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