Abstract
Purpose
Patients with early breast cancer and coexistent comorbidities generally experience worse prognosis which may be in part related to inferior treatment. Randomised data on chemotherapy use and tolerance in comorbid patients are limited. We aimed to review the available literature regarding the use of chemotherapy in such patients.
Methods
A systematic search of databases was performed for English-language articles evaluating the impact of comorbidity on chemotherapy use for early breast cancer. Comorbidity was assessed as a specific condition, summary count or index. Outcomes of interest were receipt of chemotherapy, change in chemotherapy delivery and occurrence of toxicity.
Results
Sixty studies met inclusion criteria for systematic review. Thirty-three studies evaluated receipt of chemotherapy, with 19 reporting reduced treatment, particularly with higher levels of comorbidity. Meta-analysis of 10 eligible studies returned odds ratios (OR’s) of 0.88 [95% confidence interval (CI) 0.80–0.96] and 0.63 (95% CI 0.49–0.80) for receipt of chemotherapy by patients with comorbidity scores of 1 and ≥2, respectively, compared with no comorbidity. Comorbidity had a generally adverse impact on the quality of chemotherapy delivery, although outcomes were heterogeneous. Toxicity was greater in patients with comorbidity, with 10 out of 13 studies reporting greater odds of toxicity or hospitalisation during chemotherapy. Meta-analysis of three studies addressing chemotherapy-associated hospitalisation produced OR’s of 1.42 (95% CI 1.20–1.67) and 2.23 (95% CI 1.46–3.39) for comorbidity scores of 1 and ≥2, respectively.
Conclusions
Compared with their non-comorbid counterparts, comorbid patients with early breast cancer receive less quality adjuvant chemotherapy and experience greater toxicity.
Similar content being viewed by others
References
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108
Hankinson S, Tamimi R, Hunter D (2008) Breast cancer. In: Adami H-O, Hunter D, Trichopoulos D (eds) Textbook of cancer epidemiology. Oxford University Press, New York
Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6(5):376–380
United Nations Department of Economic and Social Affairs Population Division (2015) World population prospects: the 2015 revision, key findings and advance tables. United Nations, New York
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717
Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn H-J, André F, Baselga J (2015) Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 26(8):1533–1546
Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, Housman MG, Escarce JJ (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21(7):1383–1389
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med 151(4):264–270
Higgins J, Altman D, Sterne J (2011) Chapter 8: assessing risk of bias in included studies. In: Higgins JP, Green S (ed) Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration. http://handbook.cochrane.org/ (updated March 2011, cited 9 May 2016)
Wells GA, Shea B, O’Connell D, Peterson JEA, Welch V, Losos M, Tugwell P (2011) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. The Ottawa Hospital Research Institute. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (cited 9 May 2016)
Hurria A, Muss H (2015) Special issues in older women with breast cancer. In: Ganz P (ed) Improving outcomes for breast cancer survivors: perspectives on research challenges and opportunities. Springer, Cham, pp 23–37
Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120(2):104–110
Review Manager computer program (RevMan, 2014). Version 5.3. The Cochrane Collaboration, Copenhagen (cited May 2016)
Banerjee M, George J, Yee C, Hryniuk W, Schwartz K (2007) Disentangling the effects of race on breast cancer treatment. Cancer 110(10):2169–2177
Barcenas CH, Zhang N, Zhao H, Duan Z, Buchholz TA, Hortobagyi GN, Giordano SH (2012) Anthracycline regimen adherence in older patients with early breast cancer. Oncologist 17(3):303–311
Barcenas CH, Niu J, Zhang N, Zhang Y, Buchholz TA, Elting LS, Hortobagyi GN, Smith BD, Giordano SH (2014) Risk of hospitalization according to chemotherapy regimen in early-stage breast cancer. J Clin Oncol 32(19):2010–2017
Bhargava A, Du XL (2009) Racial and socioeconomic disparities in adjuvant chemotherapy for older women with lymph node-positive, operable breast cancer. Cancer 115(13):2999–3008
Bowles EJA, Wellman R, Feigelson HS, Onitilo AA, Freedman AN, Delate T, Allen LA, Nekhlyudov L, Goddard KAB, Davis RL et al (2012) Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: a retrospective cohort study. J Natl Cancer Inst 104(17):1293–1305
Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, Caan BJ (2012) Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer Epidemiol Biomark Prev 21(7):1115–1125
Brewster AM, Etzel C, Zhou R, Wong Y, Edge S, Blayney DW, Wilson J, Hudis C, Ottesen R, Hughes ME et al (2011) The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers. Breast Cancer Res Treat 130(3):897–904
Carroll JP, Protani MM, Nguyen L, Cheng ME, Fay M, Saleem M, Pillay PS, Walpole E, Martin JH (2014) Toxicity and tolerability of adjuvant breast cancer chemotherapy in obese women. Med Oncol 31(4):881
Chan A, Chen C, Chiang J, Tan SH, Ng R (2012) Incidence of febrile neutropenia among early-stage breast cancer patients receiving anthracycline-based chemotherapy. Support Care Cancer 20(7):1525–1532
DeMichele A, Putt M, Zhang Y, Glick JH, Norman S (2003) Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients. Cancer 97(9):2150–2159
Doyle JJ, Neugut AI, Jacobson JS, Grann VR, Hershman DL (2005) Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol 23(34):8597–8605
Du XL, Zhang Y, Parikh RC, Lairson DR, Cai Y (2015) Comparative effectiveness of chemotherapy regimens in prolonging survival for two large population-based cohorts of elderly adults with breast and colon cancer in 1992–2009. J Am Geriatr Soc 63(8):1570–1582
Elkin EB, Hurria A, Mitra N, Schrag D, Panageas KS (2006) Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 24(18):2757–2764
Enewold L, Zhou J, McGlynn KA, Anderson WF, Shriver CD, Potter JF, Zahm SH, Zhu K (2012) Racial variation in breast cancer treatment among Department of Defense beneficiaries. Cancer 118(3):812–820
Enger SM, Thwin SS, Buist DS, Field T, Frost F, Geiger AM, Lash TL, Prout M, Yood MU, Wei F et al (2006) Breast cancer treatment of older women in integrated health care settings. J Clin Oncol 24(27):4377–4383
Enright K, Grunfeld E, Yun L, Moineddin R, Ghannam M, Dent S, Eisen A, Trudeau M, Kaizer L, Earle C et al (2015) Population-based assessment of emergency room visits and hospitalizations among women receiving adjuvant chemotherapy for early breast cancer. J Oncol Pract 11(2):126–132
Fedewa SA, Ward EM, Stewart AK, Edge SB (2010) Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: a national cohort study 2004–2006. J Clin Oncol 28(27):4135–4141
Freedman RA, Vaz-Luis I, Barry WT, Lii H, Lin NU, Winer EP, Keating NL (2014) Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy. Breast Cancer Res Treat 145(2):491–501
Garg P, Rana F, Gupta R, Buzaianu EM, Guthrie TH (2009) Predictors of toxicity and toxicity profile of adjuvant chemotherapy in elderly breast cancer patients. Breast J 15(4):404–408
Gennari R, Curigliano G, Rotmensz N, Robertson C, Colleoni M, Zurrida S, Nole F, de Braud F, Orlando L, Leonardi MC et al (2004) Breast carcinoma in elderly women: features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer 101(6):1302–1310
Giordano SH, Hortobagyi GN, Kau SW, Theriault RL, Bondy ML (2005) Breast cancer treatment guidelines in older women. J Clin Oncol 23(4):783–791
Giordano SH, Duan Z, Kuo YF, Hortobagyi GN, Goodwin JS (2006) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 24(18):2750–2756
Gorin SS, Heck JE, Albert S, Hershman D (2005) Treatment for breast cancer in patients with Alzheimer’s disease. J Am Geriatr Soc 53(11):1897–1904
Griffiths RI, Gleeson ML, Valderas JM, Danese MD (2014) Impact of undetected comorbidity on treatment and outcomes of breast cancer. Int J Breast Cancer 970–780. doi:10.1155/2014/970780 (cited 22 March 2016)
Griggs JJ, Sorbero ME, Stark AT, Heininger SE, Dick AW (2003) Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat 81(1):21–31
Griggs JJ, Sorbero MES, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165(11):1267–1273
Griggs JJ, Culakova E, Sorbero ME, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH (2007) Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol 25(18):2522–2527
Griggs JJ, Culakova E, Sorbero ME, van Ryn M, Poniewierski MS, Wolff DA, Crawford J, Dale DC, Lyman GH (2007) Effect of patient socioeconomic status and body mass index on the quality of breast cancer adjuvant chemotherapy. J Clin Oncol 25(3):277–284
Griggs JJ, Liu Y, Sorbero ME, Jagielski CH, Maly RC (2014) Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy. Breast Cancer Res Treat 144(3):665–672
Hawfield A, Lovato J, Covington D, Kimmick G (2006) Retrospective study of the effect of comorbidity on use of adjuvant chemotherapy in older women with breast cancer in a tertiary care setting. Crit Rev Oncol Hematol 59(3):250–255
Hershman D, McBride R, Jacobson JS, Lamerato L, Roberts K, Grann VR, Neugut AI (2005) Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol 23(27):6639–6646
Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI (2006) Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat 99(3):313–321
Javid SH, He H, Korde LA, Flum DR, Anderson BO (2014) Predictors and outcomes of completion axillary node dissection among older breast cancer patients. Ann Surg Oncol 21(7):2172–2180
Jitawatanarat P, O’Connor TL, Kossoff EB, Levine EG, Chittawatanarat K, Ngamphaiboon N (2014) Safety and tolerability of docetaxel, cyclophosphamide, and trastuzumab compared to standard trastuzumab-based chemotherapy regimens for early-stage human epidermal growth factor receptor 2-positive breast cancer. J Breast Cancer 17(4):356–362
Kadakia A, Rajan SS, Abughosh S, Du XL, Johnson ML (2015) CMF-regimen preferred as first-course chemotherapy for older and sicker women with breast cancer. Am J Clin Oncol 38(2):165–173
Kaplan MA, Pekkolay Z, Kucukoner M, Inal A, Urakci Z, Ertugrul H, Akdogan R, Firat U, Yildiz I, Isikdogan A (2012) Type 2 diabetes mellitus and prognosis in early stage breast cancer women. Med Oncol 29(3):1576–1580
Kimmick G, Camacho F, Foley KL, Levine EA, Balkrishnan R, Anderson R (2006) Racial differences in patterns of care among Medicaid-enrolled patients with breast cancer. J Oncol Pract 2(5):205–213
Klepin HD, Pitcher BN, Ballman KV, Kornblith AB, Hurria A, Winer EP, Hudis C, Cohen HJ, Muss HB, Kimmick GG (2014) Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer on a clinical trial: CALGB 49907 and CALGB 361004 (alliance). J Oncol Pract 10(5):e285–e292
Kurian AW, Lichtensztajn DY, Keegan THM, Leung RW, Shema SJ, Hershman DL, Kushi LH, Habel LA, Kolevska T, Caan BJ et al (2013) Patterns and predictors of breast cancer chemotherapy use in Kaiser Permanente Northern California, 2004–2007. Breast Cancer Res Treat 137(1):247–260
Land L, Dalton S, Jensen M, Ewertz M (2012) Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer. Br J Cancer 107(11):1901–1907
Lipscomb J, Gillespie TW, Goodman M, Richardson LC, Pollack LA, Ryerson AB, Ward KC (2012) Black–White differences in receipt and completion of adjuvant chemotherapy among breast cancer patients in a rural region of the US. Breast Cancer Res Treat 133(1):285–296
Ma C-D, Zhou Q, Nie X-Q, Liu G-Y, Di G-H, Wu J, Lu J-S, Yang W-T, Chen J-Y, Shao Z-M et al (2009) Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns. Crit Rev Oncol Hematol 71(3):258–265
Mandelblatt JS, Hadley J, Kerner JF, Schulman KA, Gold K, Dunmore-Griffith J, Edge S, Guadagnoli E, Lynch JJ, Meropol NJ (2000) Patterns of breast carcinoma treatment in older women. Cancer 89(3):561–573
Mandelblatt JS, Sheppard VB, Hurria A, Kimmick G, Isaacs C, Taylor KL, Kornblith AB, Noone AM, Luta G, Tallarico M et al (2010) Breast cancer adjuvant chemotherapy decisions in older women: the role of patient preference and interactions with physicians. J Clin Oncol 28(19):3146–3153
Muss HB, Hunter CP, Wesley M, Correa P, Chen VW, Greenberg RS, Eley JW, Austin DF, Kurman R, Edwards BK (1992) Treatment plans for Black and White women with stage II node-positive breast cancer. The National Cancer Institute Black/White cancer survival study experience. Cancer 70(10):2460–2467
Nagel G, Rohrig B, Hoyer H, Wedding U, Katenkamp D (2003) A population-based study on variations in the use of adjuvant systemic therapy on postmenopausal patients with early stage breast cancer. J Cancer Res Clin Oncol 129(3):183–191
Nuzzo F, Morabito A, De Maio E, Di Rella F, Gravina A, Labonia V, Landi G, Pacilio C, Piccirillo MC, Rossi E (2008) Weekly docetaxel versus CMF as adjuvant chemotherapy for elderly breast cancer patients: safety data from the multicentre phase 3 randomised ELDA trial. Crit Rev Oncol Hematol 66(2):171–180
O’Connor TL, Edge SB, Kossoff EB, Groman A, Wilding GE, Ademuyiwa FO, Levine EG, Watroba N, Ngamphaiboon N (2012) Factors affecting the delivery of adjuvant/neoadjuvant chemotherapy in older women with breast cancer. J Geriatr Oncol 3(4):320–328
Rocque G, Onitilo A, Engel J, Pettke E, Boshoven A, Kim K, Rishi S, Waack B, Wisinski KB, Tevaarwerk A (2012) Adjuvant therapy for HER2+ breast cancer: practice, perception, and toxicity. Breast Cancer Res Treat 131(2):713–721
Sabatino SA, Thompson TD, Wu XC, Fleming ST, Kimmick GG, Trentham-Dietz A, Cress R, Anderson RT (2014) The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer. Breast Cancer Res Treat 146(1):199–209
Schwenkglenks M, Pettengell R, Jackisch C, Paridaens R, Constenla M, Bosly A, Szucs TD, Leonard R (2011) Risk factors for chemotherapy-induced neutropenia occurrence in breast cancer patients: data from the INC-EU prospective observational European neutropenia study. Support Care Cancer 19(4):483–490
Shayne M, Crawford J, Dale DC, Culakova E, Lyman GH (2006) Predictors of reduced dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy. Breast Cancer Res Treat 100(3):255–262
Shayne M, Culakova E, Wolff D, Poniewierski MS, Dale DC, Crawford J, Lyman GH (2009) Dose intensity and hematologic toxicity in older breast cancer patients receiving systemic chemotherapy. Cancer 115(22):5319–5328
Simon MS, Lamerato L, Krajenta R, Booza JC, Ruterbusch JJ, Kunz S, Schwartz K (2012) Racial differences in the use of adjuvant chemotherapy for breast cancer in a large urban integrated health system. Int J Breast Cancer. doi:10.1155/2012/453985 (cited 22 March 2016)
Srokowski TP, Fang S, Hortobagyi GN, Giordano SH (2009) Impact of diabetes mellitus on complications and outcomes of adjuvant chemotherapy in older patients with breast cancer. J Clin Oncol 27(13):2170–2176
Von Minckwitz G, Conrad B, Reimer T, Decker T, Eidtmann H, Eiermann W, Hackmann J, Mobus V, Marme F, Potenberg J et al (2015) A randomized phase 2 study comparing EC or CMF versus nab-paclitaxel plus capecitabine as adjuvant chemotherapy for nonfrail elderly patients with moderate to high-risk early breast cancer (ICE II-GBG 52). Cancer 121(20):3639–3648
Wheeler SB, Carpenter WR, Peppercorn J, Schenck AP, Weinberger M, Biddle AK (2012) Predictors of timing of adjuvant chemotherapy in older women with hormone receptor-negative, stages II–III breast cancer. Breast Cancer Res Treat 131(1):207–216
Woodard S, Nadella PC, Kotur L, Wilson J, Burak WE, Shapiro CL (2003) Older women with breast carcinoma are less likely to receive adjuvant chemotherapy: evidence of possible age bias? Cancer 98(6):1141–1149
Zauderer M, Patil S, Hurria A (2009) Feasibility and toxicity of dose-dense adjuvant chemotherapy in older women with breast cancer. Breast Cancer Res Treat 117(1):205–210
Zhu Z, Huo Q, Wang S, Yang Q (2015) Occupational type affects the receipt of breast cancer adjuvant chemotherapy in China. Oncol Lett 10(4):2547–2552
Terret C, Albrand G, Rainfray M, Soubeyran P (2015) Impact of comorbidities on the treatment of non-Hodgkin’s lymphoma: a systematic review. Expert Rev Hematol 8(3):329–341
Lee L, Cheung WY, Atkinson E, Krzyzanowska MK (2011) Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J Clin Oncol 29(1):106–117
Louwman W, Janssen-Heijnen M, Houterman S, Voogd A, Van Der Sangen M, Nieuwenhuijzen G, Coebergh J (2005) Less extensive treatment and inferior prognosis for breast cancer patients with comorbidity: a population-based study. Eur J Cancer 41(5):779–785
Janssen-Heijnen ML, Houterman S, Lemmens VE, Louwman MW, Maas HA, Coebergh JWW (2005) Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol 55(3):231–240
Naeim A, Hurria A, Leake B, Maly RC (2006) Do age and ethnicity predict breast cancer treatment received? A cross-sectional urban population based study: breast cancer treatment: age and ethnicity. Crit Rev Oncol Hematol 59(3):234–242
Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285(7):885–892
Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 88(11):716–726
Vulto AJ, Lemmens VE, Louwman MW, Janssen-Heijnen ML, Poortmans PH, Lybeert ML, Coebergh JWW (2006) The influence of age and comorbidity on receiving radiotherapy as part of primary treatment for cancer in South Netherlands, 1995 to 2002. Cancer 106(12):2734–2742
Jagsi R, Abrahamse P, Morrow M, Griggs JJ, Schwartz K, Katz SJ (2009) Postmastectomy radiotherapy for breast cancer. Cancer 115(6):1185–1193
Wu AH, Kurian AW, Kwan ML, John EM, Lu Y, Keegan TH, Gomez SL, Cheng I, Shariff-Marco S, Caan BJ (2015) Diabetes and other comorbidities in breast cancer survival by race/ethnicity: the California Breast Cancer Survivorship Consortium (CBCSC). Cancer Epidemiol Biomark Prev 24(2):361–368
Berglund A, Wigertz A, Adolfsson J, Ahlgren J, Fornander T, Wärnberg F, Lambe M (2012) Impact of comorbidity on management and mortality in women diagnosed with breast cancer. Breast Cancer Res Treat 135(1):281–289
Hurria A, Leung D, Trainor K, Borgen P, Norton L, Hudis C (2003) Factors influencing treatment patterns of breast cancer patients age 75 and older. Crit Rev Oncol Hematol 46(2):121–126
Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai W-Y, Fehrenbacher L, Gomez SL, Miles S, Neugut AI (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8,769 early-stage breast cancer patients. J Clin Oncol. doi:10.1200/JCO.2009.25.9655
Hong C-C, Ambrosone CB, Goodwin PJ (2015) Comorbidities and their management: potential impact on breast cancer outcomes. In: Ganz PA (ed) Improving outcomes for breast cancer survivors: perspectives on research challenges and opportunities. Springer, p 155–175. doi:10.1007/978-3-319-16366-6
Patnaik JL, Byers T, DiGuiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103(14):1101–1111
Satariano WA (2000) Comorbidities and cancer. In: Hunter C, Johnson K, Muss H (eds) Basic and clinical oncology: cancer in the elderly, vol 23. CRC Press, New York, pp 477–500
El Shayeb M, Scarfe A, Yasui Y, Winget M (2012) Reasons physicians do not recommend and patients refuse adjuvant chemotherapy for stage III colon cancer: a population based chart review. BMC Res Notes 5(269):8
Gross CP, McAvay GJ, Guo Z, Tinetti ME (2007) The impact of chronic illnesses on the use and effectiveness of adjuvant chemotherapy for colon cancer. Cancer 109(12):2410–2419
Bradley CJ, Dahman B, Anscher M (2014) Prostate cancer treatment and survival: evidence for men with prevalent comorbid conditions. Med Care 52(6):482–489
Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J, Olivotto IA (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 24(30):4888–4894
de Melo Gagliato D, Gonzalez-Angulo AM, Lei X, Theriault RL, Giordano SH, Valero V, Hortobagyi GN, Chavez-MacGregor M (2014) Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol. doi:10.1200/JCO.2013.49.7693
Wood WC, Budman DR, Korzun AH, Cooper MR, Younger J, Hart RD, Moore A, Ellerton JA, Norton L, Ferree CR (1994) Dose and dose intensity of adjuvant chemotherapy for stage II, node-positive breast carcinoma. N Engl J Med 330(18):1253–1259
Budman DR, Berry DA, Cirrincione CT, Henderson IC, Wood WC, Weiss RB, Ferree CR, Muss HB, Green MR, Norton L (1998) Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. J Natl Cancer Inst 90(16):1205–1211
Ferguson T, Wilcken N, Vagg R, Ghersi D, Nowak AK (2007) Taxanes for adjuvant treatment of early breast cancer. Cochrane Database Syst Rev 4. doi:10.1002/14651858.CD004421.pub2/epdf (cited 22 Feb 2017)
Shulman LN, Berry DA, Cirrincione CT, Becker HP, Perez EA, O’Regan R, Martino S, Shapiro CL, Schneider CJ, Kimmick G (2014) Comparison of doxorubicin and cyclophosphamide versus single-agent paclitaxel as adjuvant therapy for breast cancer in women with 0 to 3 positive axillary nodes: CALGB 40101 (alliance). J Clin Oncol 32(22):2311–2317
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100000 women in 123 randomised trials. Lancet 379(9814):432–444
Feinstein AR (1970) The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis 23(7):455–468
Sarfati D (2012) Review of methods used to measure comorbidity in cancer populations: no gold standard exists. J Clin Epidemiol 65(9):924–933
Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JDF, Feuer EJ (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353(17):1784–1792
Land LH, Dalton SO, Jensen M-B, Ewertz M (2012) Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990–2008. Breast Cancer Res Treat 131(3):1013–1020
Cronin-Fenton D, Nørgaard M, Jacobsen J, Garne J, Ewertz M, Lash T, Sørensen H (2007) Comorbidity and survival of Danish breast cancer patients from 1995 to 2005. Br J Cancer 96(9):1462–1468
Funding
This work was supported by the University of Auckland (Research Fellow in Surgery), the Cancer Society of New Zealand (Training Scholarship in Cancer Research), the Health Research Council (Clinical Research Training Scholarship 17/016) and the Waikato Breast Cancer Research Trust.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards
No ethical approval was required.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplemental material—Fig. 1 PRISMA flowchart of study selection
Rights and permissions
About this article
Cite this article
Edwards, M.J., Campbell, I.D., Lawrenson, R.A. et al. Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 165, 17–39 (2017). https://doi.org/10.1007/s10549-017-4295-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-017-4295-4