N. Bhoo-Pathy

Advanced Stage at Presentation Remains a Major Factor Contributing to Breast Cancer Survival Disparity between Public and Private Hospitals in a Middle-Income Country

Background: Survival disparities in cancer are known to occur between public and private hospitals. We compared breast cancer presentation, treatment and survival between a public academic hospital and a private hospital in a middle-income country. Methods: The demographics, clinical characteristics, treatment and overall survival (OS) of 2767 patients with invasive breast carcinoma diagnosed between 2001 and 2011 in the public hospital were compared with 1199 patients from the private hospital. Results: Compared to patients in the private hospital, patients from the public hospital were older at presentation, and had more advanced cancer stages. They were also more likely to receive mastectomy and chemotherapy but less radiotherapy. The five-year OS in public patients was significantly lower than in private patients (71.6% vs. 86.8%). This difference was largely attributed to discrepancies in stage at diagnosis and, although to a much smaller extent, to demographic differences and treatment disparities. Even following adjustment for these factors, patients in the public hospital remained at increased risk of mortality compared to their counterparts in the private hospital (Hazard Ratio: 1.59; 95% Confidence Interval: 1.36–1.85). Conclusion: Late stage at diagnosis appears to be a major contributing factor explaining the breast cancer survival disparity between public and private patients in this middle-income setting.

Employment Challenges Faced by Breast Cancer Survivors in an Upper Middle–Income Asian Setting

Background: Cancer survivorship as an area, which focuses on the health and life of an individual following cancer diagnosis and treatment is increasingly being recognized as an important component of the cancer control continuum. Advances in breast cancer detection and treatments have resulted in a growing number of patients experiencing a breast cancer diagnosis at an age when career plays an important role in their lives. Yet, very little is known on how breast cancer affects employment and return to work among survivors, particularly in low- and middle-income settings. Aim: This qualitative study aims to gain an in-depth understanding on employment challenges and motivators/barriers in return to work faced by breast cancer survivors in an upper-middle income Asian setting. Methods: Eleven focus group discussions (FGDs) were conducted with breast cancer survivors representing various ethnicities and socioeconomic backgrounds in Malaysia. Patients diagnosed one to two years prior to the study were recru...

Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings: Breast-conserving surgery versus mastectomy in young Asian women

Mastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early‐stage breast cancer in Asian settings. Survival in women treated with breast‐conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared.

Impact of adjuvant chemotherapy on survival of women with T1N0M0, hormone receptor negative breast cancer

BACKGROUND The benefit of adjuvant chemotherapy in women with T1N0M0 breast cancers is unclear. While gene expression-based prognostic assays may aid management of women with early estrogen receptor (ER) positive tumors, therapeutic decision-making in women with early stage ER negative tumors remains fraught with difficulties. We investigated the association between adjuvant chemotherapy and overall survival in women with T1N0M0, hormone receptor negative breast cancers. METHOD All newly diagnosed breast cancer patients with node-negative and hormone receptor negative tumors measuring≤2cm at the University Malaya Medical Centre (Malaysia) from 1993 to 2013 were included. Mortality of patients with and without adjuvant chemotherapy were compared and adjusted for possible confounders using propensity score. RESULTS Of 6732 breast cancer patients, 341 (5.1%) had small (≤2cm), node-negative and hormone receptor negative tumors at diagnosis. Among them, only 214 (62.8%) received adjuvant chemotherapy. Five-year overall survival was 88.1% (95% confidence interval (CI): 82.0%-94.2%) for patients receiving chemotherapy and 89.6% (95% CI: 85.1%-94.1%) for patients without chemotherapy. Chemotherapy was not associated with survival following adjustment for age, ethnicity, tumor size, tumor grade, HER2 status, lympho-vascular invasion, type of surgery and radiotherapy administration. However, chemotherapy was associated with a significant survival advantage (adjusted hazard ratio: 0.35, 95%CI: 0.14-0.91) in a subgroup of women with high-grade tumors. CONCLUSION Adjuvant chemotherapy does not appear to be associated with a survival benefit in women with T1N0M0, hormone receptor negative breast cancer except in those with high-grade tumors.

Abstract P6-06-28: Survival gain in patients with de novo metastatic breast cancer in past two decades is largely attributable to treatment

Background: In Asia, a substantial proportion of breast cancer patients present with distant metastases at diagnosis. We determined whether metastatic breast cancer survival has improved in a multi-ethnic Asian setting over a span of fifteen years, and disentangled the contribution of various factors on the observed survival trend. Methods: Patients diagnosed with de novo metastatic breast cancer from three hospitals in Malaysia and Singapore (N = 856) were assigned to three cohorts by year of diagnosis: 1996-2000, 2001-2005 and 2006-2010. Time trends in disease characteristics, treatment, and relative survival rates (RSR) were compared. Adjusted relative excess risks of mortality in recent periods were estimated using a step-wise Poisson regression to assess the contributions of several prognostic factors towards the observed survival pattern. Results: The proportion of patients presenting with de novo metastatic breast cancer remained fairly stable at 10% in 1996-2000, 7% in 2001-2005, and 9% in 2006 -2010. Recently diagnosed patients were older, and more likely to have multiple metastatic sites involved, and visceral metastases. Surgery of primary tumor became more prevalent over time, and this is also complemented with higher attainments of free surgical margins. Chemotherapy, and endocrine therapy administration also increased with time, with higher use of taxane-based regimens in recent periods. The three-year RSR in the above periods were 20.6% (95%CI: 13.9%-28.2%, median survival = 14 months), 28.8% (95%CI: 23.4%-34.2%, median survival = 18 months), and 33.6% (95%CI: 28.8%-38.5%, median survival = 21 months), respectively. Surgery of the primary tumor explained most of the observed survival gain in the latest period, followed by chemotherapy, and endocrine therapy. Conclusion: The modest survival gain in patients with de novo metastatic breast cancer in Asian settings is largely attributable to improvement in treatment strategies, namely surgery of primary tumor and other treatment modalities. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-28.