Background:
Adjuvant chemotherapy is recommended for many breast cancer patients with node positive disease. Decisions to treat older women with chemotherapy are complex due to issues such as toxicity or pre-existing comorbidities. We focus on women aged under 70 and present data on chemotherapy utilisation rates for Queensland breast cancer patients with node positive disease.
Methods:
Data on female breast cancer patients diagnosed between 2000 and 2014 were extracted from the Queensland Oncology Repository (QOR). Matched chemotherapy data for these patients was also sourced from QOR. Data was limited to those patients receiving intravenous chemotherapy.
Results:
Breast cancer was the most common cancer for women during the 15 year period with almost 40,000 women having a breast cancer diagnosed. Three-quarters of breast cancer patients were aged under 70. The total number of women aged under 70 with node positive disease was 9,825.
The state-wide chemotherapy utilisation rate was 85%, with rates across the state Hospital and Health Services (HHS) ranging from 79% in Townsville HHS to 92% in South West HHS. Within this cohort chemotherapy rates were high (87% or higher) in all age groups until women aged 60-64 and 65-69 where rates began to decline (77% and 68% respectively). There were no differences between utilisation rates among urban and rural women (both 85%). Minor differences were observed across the socio-economic gradient, with 89% of women from affluent areas having chemotherapy while only 82% of women in areas of socioeconomic disadvantage were treated with chemotherapy. Women with two or more comorbidities also experienced lower rates of chemotherapy (79%).
Conclusions:
Chemotherapy as a treatment for node-positive breast cancer patients in Queensland is widely used, with little variation in utilisation rates across the state. Lower rates appear to be due to known factors such as increasing age or the presence of comorbidities