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Prediction of Other-Cause Mortality in Older Patients with Breast Cancer Using Comorbidity

Anna Z de Boer1,2, Esther Bastiaannet1,2, Hein Putter3

  • 1Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.

Cancers
|April 30, 2021
PubMed

Insights

A simple comorbidity count is as effective as the Charlson comorbidity index for predicting other-cause mortality in older breast cancer patients. This finding supports using comorbidity count for personalized treatment strategies in this demographic.

Area of Science:

  • Oncology
  • Geriatrics
  • Epidemiology

Background:

  • Individualized treatment for older breast cancer patients requires accurate prediction of other-cause mortality.
  • Existing prediction tools may not optimally incorporate comorbidity data, which is crucial given age-related mortality risks.
  • No definitive comorbidity scoring system is established for this specific purpose.

Purpose of the Study:

  • To compare the predictive performance of the Charlson comorbidity index against a simple comorbidity count for 5-year other-cause mortality in older breast cancer patients.
  • To evaluate the impact of specific, frequently occurring comorbidities on other-cause mortality.
  • To assess the utility of these measures in improving individualized treatment strategies.

Main Methods:

  • Retrospective cohort study using the Netherlands Cancer Registry.
  • Inclusion of surgically treated patients aged ≥70 years with stages I-III breast cancer (2003-2009).
  • Competing risk analysis to evaluate the association between comorbidities (Charlson index, comorbidity count, specific conditions) and 5-year other-cause mortality, including discrimination and calibration assessment.

Main Results:

  • 7511 patients were analyzed; 26% died from other causes within 5 years.
  • The Charlson comorbidity index and simple comorbidity count demonstrated similar predictive values (c-statistics: 0.65 and 0.64, respectively).
  • Psychiatric disease showed a strong association with other-cause mortality (sHR 2.44), independent of the Charlson index components.

Conclusions:

  • The Charlson comorbidity index and a simple comorbidity count have comparable predictive value for 5-year other-cause mortality in older breast cancer patients.
  • Comorbidity count offers a more practical tool for clinical use, potentially aiding in the individualization of treatment.
  • Further research incorporating geriatric parameters may enhance prediction accuracy.

Keywords:
breast cancercomorbiditycompeting for mortalityindividualized treatmentolder patients

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