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Open AccessArticle

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

1
Department of Internal Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Peter Debyelaan 25, 6229 HX Maastricht, The Netherlands
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ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
3
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
4
Department of Public Health, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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Department of Clinical Epidemiology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands
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Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(9), 1239; https://doi.org/10.3390/cancers11091239
Received: 10 June 2019 / Revised: 16 August 2019 / Accepted: 19 August 2019 / Published: 23 August 2019
(This article belongs to the Special Issue Treatment Strategies and Survival Outcomes in Breast Cancer)
Previous studies showed substantial improvement of survival rates in patients with cancer in the last two decades. However, lower survival rates have been reported for older patients compared to younger patients. In this population-based study, we analyzed treatment patterns and the survival of patients with breast cancer (BC) and colorectal cancer (CRC). Patients with stages I–III BC and CRC and diagnosed between 2003 and 2012 were selected from the Netherlands Cancer Registry (NCR). Trends in treatment modalities were evaluated with the Cochran-Armitage trend test. Trends in five-year overall survival were calculated with the Cox hazard regression model. The Ederer II method was used to calculate the five-year relative survival. The relative excess risk of death (RER) was estimated using a multivariate generalized linear model. During the study period, 98% of BC patients aged <75 years underwent surgery, whereas for patients ≥75 years, rates were 79.3% in 2003 and 66.7% in 2012 (p < 0.001). Most CRC patients underwent surgery irrespective of age or time period, although patients with rectal cancer aged ≥75 years received less surgery or radiotherapy over the entire study period than younger patients. The administration of adjuvant chemotherapy increased over time for CRC and BC patients, except for BC patients aged ≥75 years. The five-year relative survival improved only in younger BC patients (adjusted RER 0.95–0.96 per year), and was lower for older BC patients (adjusted RER 1.00, 95% Confidence Interval (CI) 0.98–1.02, and RER 1.00; 95% CI 0.98–1.01 per year for 65–74 years and ≥75 years, respectively). For CRC patients, the five-year relative survival improved over time for all ages (adjusted RER on average was 0.95 per year). In conclusion, the observed survival trends in BC and CRC patients suggest advances in cancer treatment, but with striking differences in survival between older and younger patients, particularly for BC patients. View Full-Text
Keywords: breast cancer; colorectal cancer; relative survival; older patients; geriatric oncology; cancer treatment breast cancer; colorectal cancer; relative survival; older patients; geriatric oncology; cancer treatment
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van Abbema, D.; Vissers, P.; de Vos-Geelen, J.; Lemmens, V.; Janssen-Heijnen, M.; Tjan-Heijnen, V. Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer. Cancers 2019, 11, 1239.

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