Prevalence and risk of skeletal complications and use of radiation therapy in elderly women diagnosed with metastatic breast cancer

Real-world data regarding patient factors associated with the occurrence of spinal cord compression (SCC) or pathological fracture (PF), or need for bone surgery (BS), or use of radiation therapy (RAD) (i.e. skeletal complications and radiation therapy; SCRT) are limited for women with metastatic br...

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Published in:PloS one Vol. 13; no. 3; p. e0193661
Main Authors: Hussain, Arif, Yong, Candice, Tkaczuk, Katherine H. R., Qian, Yi, Arellano, Jorge, Mullins, C. Daniel, Onukwugha, Eberechukwu
Format: Journal Article
Language:English
Published: United States Public Library of Science 01.03.2018
Public Library of Science (PLoS)
Subjects:
Aged
Aged, 80 and over
Biology and Life Sciences
Bone transplantation
Breast Neoplasms - epidemiology
Breast Neoplasms - radiotherapy
Care and treatment
Female
Fractures, Spontaneous - epidemiology
Fractures, Spontaneous - etiology
Fractures, Spontaneous - surgery
Humans
Medicare
Medicine and Health Sciences
Neoplasm Metastasis
Prevalence
Radiotherapy
Risk Factors
SEER Program
Spinal cord compression
Spinal Cord Compression - epidemiology
Spinal Cord Compression - etiology
Spinal Cord Compression - surgery
United States - epidemiology
ISSN:1932-6203, 1932-6203
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Summary:Real-world data regarding patient factors associated with the occurrence of spinal cord compression (SCC) or pathological fracture (PF), or need for bone surgery (BS), or use of radiation therapy (RAD) (i.e. skeletal complications and radiation therapy; SCRT) are limited for women with metastatic breast cancer (BCa). Given the substantial clinical and economic burden of these events in advanced BCa, we conducted the present study to understand the prevalence and identify the risk factors associated with these events among elderly women presenting with de novo metastatic BCa. Using linked Surveillance, Epidemiology, and End Results and Medicare data, we identified women with incident metastatic BCa diagnosed during 2005-2009. Associations between patient demographics and select clinically relevant factors, and SCRT were examined using the Cox proportional hazards model, accounting for death as a competing risk. Of 3,731 Medicare beneficiaries with incident metastatic BCa, 1,808 (48.5%) experienced at least one SCRT event during a median follow-up of 13.2 months; a majority (69%) experienced a subsequent SCRT event. The proportions of women who had RAD, PF, BS, and SCC were: 32%, 28%, 8%, and 4%. Older women (80+ years), or those with more comorbid conditions (CCI≥2) had a statistically significant lower risk of SCRT (HR 0.78 [CI: 0.67-0.92, p<0.01]; HR 0.77 [CI: 0.67-0.89, p<0.01], respectively), primarily due to lower frequency of radiotherapy (p<0.01). Compared to Caucasians, African Americans had lower risk of SCRT (HR 0.70 [CI: 0.60-0.82, p<0.01]), as well as all SCRT subtypes defining this group except for SCC, which was the same for both race groups. This study highlights that certain patient characteristics and clinical factors are associated with the risk of spinal cord compression or pathologic fractures, or need for bone surgery or radiation among women with metastatic BCa. In future studies, it will also be important to consider the clinical and economic burden based on these components of skeletal complications and radiation therapy use in order to guide and improve the management of women with advanced BCa.
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Current address: AstraZeneca, Gaithersburg, MD, United States of America
Competing Interests: AH: Research funding – Amgen; Department of Veterans Affairs Merit Review Award. CY: Employment - AstraZeneca. KHRT: None. YQ: Employment – Amgen. Stock – Amgen. JA: Employment – Amgen. Stock – Amgen. CDM: Consulting/Advisory Role - Amgen; Bayer; Lexicon; Mundipharma; Novartis; Regeneron/Sanofi; Pfizer. Research funding – Amgen; Bayer; Pfizer. EO: Consultant/Advisory Role – AstraZeneca. Research Funding - Amgen; Bayer; Takeda. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0193661