Journal Article
. 2020 Jan;10(1).
doi: 10.1038/s41598-020-58007-5.

Impact of deviation from guideline recommended treatment on breast cancer survival in Asia

Peh Joo Ho 1 Samuel Guan Wei Ow 2 Yirong Sim 3 Jenny Liu 4 Swee Ho Lim 5 Ern Yu Tan 6 Su-Ming Tan 7 Soo Chin Lee 2 Veronique Kiak-Mien Tan 3 Yoon-Sim Yap 8 Wen Yee Chay 8 Benita Kiat Tee Tan 3 Fuh Yong Wong 3 Jingmei Li 9 Mikael Hartman 4 
  • PMID: 31992769
  •     42 References


Breast cancer survival has improved with significant progress in treatment and disease management. However, compliance with treatment varies. Treatment guidelines for older patients are unclear. We aim to identify predictors of noncompliance with recommended therapy in a large breast cancer population and assess the impact of noncompliance on survival. Our study included 19,241 non-metastatic female breast cancer patients, of whom 3,158 (16%) died within 10 years post-diagnosis (median survival = 5.8 years). We studied the association between treatment noncompliance and factors with logistic regression, and the impact of treatment noncompliance on survival with a flexible parametric survival model framework. The highest proportion of noncompliance was observed for chemotherapy (18%). Predictors of noncompliance with chemotherapy, radiotherapy and endocrine therapy included age, tumor size, nodal involvement and subtype (except radiotherapy). Factors associated with not receiving surgery included age and subtype. Treatment noncompliance was associated with worse overall survival for surgery (HR: 2.26 [1.80-2.83]), chemotherapy (1.25 [1.11-1.41]), radiotherapy (2.28 [1.94-2.69]) and endocrine therapy (1.70 [1.41-2.04]). Worse survival was similarly observed in older patients for whom guidelines generally do not apply. Our results highlight the importance of following appropriate treatment as recommended by current guidelines. Older patients may benefit from similar recommendations.

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