Inclusion and Analysis of Older Adults in RCTs

Surgical oncolog

Treatment of older breast cancer patients:de-escalation in oncology

De prognose van borstkankerpatiënten is in de afgelopen decennia sterk verbeterd. Innovaties in beeldvormende technieken en pathologisch onderzoek, geoptimaliseerde chirurgische en radiotherapeutische technieken hebben daaraan bijgedragen. Een groot deel van de verbetering komt door de uitbreiding van het scala aan effectieve systemische middelen en de gestage uitbreiding van de indicatie hiervoor. Verruiming van de richtlijnen met betrekking tot aanvullende behandelingen maakt echter dat de absolute winst steeds kleiner wordt. De balans tussen effectiviteit en bijwerkingen kan hierdoor in het gedrang komen. Dat is een stimulans om te zoeken naar mogelijkheden om bepaalde aanvullende behandelingen achterwege te laten, ter preventie van de potentiële schade van die behandelingen, zonder het individuele risico op terugkeer van ziekte onnodig te vergroten. Een patiëntengroep bij wie dit momenteel onderzocht wordt in Nederland zijn oudere vrouwen met borstkanker.The prognosis of breast cancer patients has greatly improved in recent decades. Innovations in imaging techniques, pathological assessment, optimized surgical and radiotherapy techniques have contributed to this. Much of the improvement is due to the increase of the range of effective systemic treatment and the continual expansion of the indication for this purpose. However, broadening the guidelines for adjuvant systemic treatments, results in a smaller absolute gain. The balance between effectiveness and side-effects could therefore be compromised, which is an incentive to search for possibilities for de-escalation to prevent potential damage, without unnecessarily increasing the risk of recurrence. Currently, in The Netherlands this is being investigated in older breast cancer patients.</p

No Excess Mortality in Patients Aged 50 Years and Older Who Received Treatment for Ductal Carcinoma In Situ of the Breast

Background. The incidence of ductal carcinoma in situ (DCIS) has increased at a fast rate.The aim of this study was to assess the incidence and treatment in the Netherlands and estimate the excess mortality risk of DCIS. Methods. From the Netherlands Cancer Registry, adult female patients (diagnosed 1997–2005) with DCIS were selected. Treatment was described according to age. Relative mortality at 10 years of follow-up was calculated by dividing observed mortality over expected mortality. Expected mortality was calculated using the matched Dutch general population. Results. Overall, 8421 patients were included in this study. For patients aged 50–64, and 65–74 an increase in breast-conserving surgery was observed over time (P < 0.001). For patients over 75 years of age, 8.0% did not undergo surgery; this percentage remained stable over time (P = 0.07). Overall, treated patients aged >50 years experienced no excess mortality regardless of treatment (relative mortality 1.0). Conclusion. The present population-based study of almost 8500 patients showed no excess mortality in surgically treated women over 50 years with DCIS