Patterns of care and prognosis of older women with breast cancer

Kiderlen, M. (2018)

Doctoral Thesis

Older women with breast cancer are underrepresented in the available
evidence. Therefore, there is no solid evidence on how to treat older women with breast cancer.

This thesis has three main conclusions:
1. There are large international differences in the treatment strategy of breast cancer
among older women. These differences are not associated with a significant
difference in prognosis.
2. The presence of comorbidity has an important impact on the general prognosis
of older women with breast cancer. We did not show an important association
between specific comorbidities or the use of co-medications and the breast
cancer specific prognosis.
3. Concerning older women with breast cancer for research, there are very important methodological issues to take into account, including to avoidance of
selection bias and the proper methodologies to take in to account the chance of dying from another cause of cancer: the competing risk of mortality.

Future research should be done to create a tool which can assist in identifying the individualised
treatment strategy for each older woman with breast cancer. This will have to take into consideration patient’s and tumour’s information, as well as the endpoints for each individual patient.

• Breast cancer
• Geriatric oncology
• Epidemiology
• Elderly

• All authors: Kiderlen, M.
• Supervisor: Velde, C.J.H. van de
• Co-supervisor: Liefers, G.J.; Bastiaannet, E.
• Committee: Putter, H.; Portielje, J.E.A.; Smit, V.T.H.B.M.; Siesling, S.; Scholten, A.N.
• Qualification: Doctor (dr.)
• Awarding Institution: Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2018-02-14
• ISBN (print): 9789463610483