Location of receipt of initial treatment and outcomes in long-term breast cancer survivors

Arup K. Sinha, Jenil R. Patel, Yu Shen, Naoto T. Ueno, Sharon H. Giordano, Debu Tripathy, David Lopez, Carlos H. Barcenas

Research output: Contribution to journalArticle

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Abstract

Purpose: Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment. Methods: We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9-6.0; RFS: HR = 5.8, 95% CI = 4.8-7.0; DRFS: HR = 5.4, 95% CI = 4.5-6.6). Conclusion: Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.

Original languageEnglish (US)
Article numbere0170081
JournalPloS one
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

breast neoplasms
Survivors
confidence interval
Hazards
relapse
Breast Neoplasms
Survival
Recurrence
Confidence Intervals
neoplasms
observational studies
prognosis
risk factors
survival rate
Therapeutics
Kaplan-Meier Estimate
Survival Analysis
methodology
Proportional Hazards Models
Observational Studies

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Sinha, A. K., Patel, J. R., Shen, Y., Ueno, N. T., Giordano, S. H., Tripathy, D., ... Barcenas, C. H. (2017). Location of receipt of initial treatment and outcomes in long-term breast cancer survivors. PloS one, 12(1), [e0170081]. https://doi.org/10.1371/journal.pone.0170081

Location of receipt of initial treatment and outcomes in long-term breast cancer survivors. / Sinha, Arup K.; Patel, Jenil R.; Shen, Yu; Ueno, Naoto T.; Giordano, Sharon H.; Tripathy, Debu; Lopez, David; Barcenas, Carlos H.

In: PloS one, Vol. 12, No. 1, e0170081, 01.01.2017.

Research output: Contribution to journalArticle

Sinha, AK, Patel, JR, Shen, Y, Ueno, NT, Giordano, SH, Tripathy, D, Lopez, D & Barcenas, CH 2017, 'Location of receipt of initial treatment and outcomes in long-term breast cancer survivors', PloS one, vol. 12, no. 1, e0170081. https://doi.org/10.1371/journal.pone.0170081
Sinha AK, Patel JR, Shen Y, Ueno NT, Giordano SH, Tripathy D et al. Location of receipt of initial treatment and outcomes in long-term breast cancer survivors. PloS one. 2017 Jan 1;12(1). e0170081. https://doi.org/10.1371/journal.pone.0170081
Sinha, Arup K. ; Patel, Jenil R. ; Shen, Yu ; Ueno, Naoto T. ; Giordano, Sharon H. ; Tripathy, Debu ; Lopez, David ; Barcenas, Carlos H. / Location of receipt of initial treatment and outcomes in long-term breast cancer survivors. In: PloS one. 2017 ; Vol. 12, No. 1.
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abstract = "Purpose: Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment. Methods: We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95{\%} confidence intervals (CI). Results: We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1{\%} were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9{\%}, 88.4{\%}, and 89.0{\%} in the MDA-treated group and 74.3{\%}, 49.8{\%}, and 52.7{\%} in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95{\%} CI = 3.9-6.0; RFS: HR = 5.8, 95{\%} CI = 4.8-7.0; DRFS: HR = 5.4, 95{\%} CI = 4.5-6.6). Conclusion: Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.",
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