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Breast Cancer

Use of Intravenous Bisphosphonates in Older Women with Breast Cancer

^aDepartment of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA; ^bNational Institutes of Health, Bethesda, Maryland, USA; ^cSealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA

Key Words. Breast cancer • Elderly • Metastatic

Correspondence: Sharon Giordano, M.D., M.P.H., 1515 Holcombe Boulevard, Box 1354, Houston, Texas 77030, USA. Telephone: 713-792-2817; Fax: 713-794-4385; e-mail: sgiordan{at}mdanderson.org

Received October 18, 2007; accepted for publication March 24, 2008.

Disclosure: S.H.G. is supported by NIH 1K07 CA 109064–04. The funding sources had no role in the study design, conduct, data analysis, or manuscript preparation. No potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Introduction. i.v. bisphosphonates reduce skeletal events in women with bone metastases from breast cancer, but little is known about the prevalence and duration of bisphosphonate use.

Methods. Patients were identified from the Surveillance, Epidemiology, and End Results–Medicare database who were aged 65 years and were diagnosed with invasive breast cancer in 1995–2002. Healthcare Common Procedure Coding System codes were used to identify patients treated with pamidronate and zoledronic acid. Descriptive statistics were used to describe patterns of use. Multivariate analyses were performed to determine the predictors of bisphosphonate use.

Results. In total, 55,864 women with breast cancer were included, with 307,467 person-years of follow-up. Overall, 1.26% of women with all stages of breast cancer received i.v. bisphosphonates. In 2004, 2% of all breast cancer patients and 32% of patients with distant stage disease received bisphosphonates. Approximately two thirds of patients treated with bisphosphonates received zoledronic acid and one third received pamidronate in 2004. Multivariate analyses showed that patients who were 75 years old were less likely to receive bisphosphonates (75–79 years versus 65–69 years: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.70–0.93; 80+ years versus 65–69 years: OR, 0.49; 95% CI, 0.42–0.57). The use of bisphosphonates dramatically increased over time. The majority of living patients were continued on i.v. bisphosphonates once started (83% at 1 year, 64% at 3 years, 50% at 5 years), but the median survival time after initiation of i.v. bisphosphonates was only 21 months.

Conclusions. i.v. bisphosphonates appear to be underused in patients with metastatic breast cancer, particularly among those patients >75 years of age.

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