Prediction of other-cause mortality in older patients with breast cancer using comorbidity

De Boer, Anna Z.; Bastiaannet, Esther; Putter, H.; Marang-van de Mheen, P.J.; Siesling, Sabine; De Munck, Linda; De Ligt, Kelly M.; Portielje, Johanneke E.A.; Liefers, Gerrit Jan; De Glas, Nienke A.

Prediction of other-cause mortality in older patients with breast cancer using comorbidity

Journal article (2021)

Authors

Anna Z. De Boer Leiden University Medical Center

Esther Bastiaannet Leiden University Medical Center

H. Putter Leiden University Medical Center

P.J. Marang-van de Mheen Leiden University Medical Center

Sabine Siesling University of Twente, Integraal Kankercentrum Nederland (IKNL)

Linda De Munck Integraal Kankercentrum Nederland (IKNL)

Kelly M. De Ligt Integraal Kankercentrum Nederland (IKNL), University of Twente

Johanneke E.A. Portielje Leiden University Medical Center

Gerrit Jan Liefers Leiden University Medical Center

Nienke A. De Glas Leiden University Medical Center

Affiliation

External organisation

Breast cancer Comorbidity Competing for mortality Individualized treatment Older patients

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Published Date

2021

Language

English

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Abstract

Background: Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this study aimed to compare the predictive value of the Charlson comorbidity index for other-cause mortality with the use of a simple comorbidity count and to assess the impact of frequently occurring comorbidities. Methods: Surgically treated patients with stages I-III breast cancer aged ≥70 years diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. Competing risk analysis was performed to associate 5-year other-cause mortality with the Charlson index, comorbidity count, and specific comorbidities. Discrimination and calibration were assessed. Results: Overall, 7511 patients were included. Twenty-nine percent had no comorbidities, and 59% had a Charlson score of 0. After five years, in 1974, patients had died (26%), of which 1450 patients without a distant recurrence (19%). Besides comorbidities included in the Charlson index, the psychiatric disease was strongly associated with other-cause mortality (sHR 2.44 (95%-CI 1.70-3.50)). The c-statistics of the Charlson index and comorbidity count were similar (0.65 (95%-CI 0.64-0.65) and 0.64 (95%-CI 0.64-0.65)). Conclusions: The predictive value of the Charlson index for 5-year other-cause mortality was similar to using comorbidity count. As it is easier to use in clinical practice, our findings indicate that comorbidity count can aid in improving individualizing treatment in older patients with breast cancer. Future studies should elicit whether geriatric parameters could improve prediction.