Morbidity of local therapy for locally advanced metastatic breast cancer: an analysis of the Surveillance, Epidemiology, and End Results (SEER)–Medicare Registry

Purpose Limited data exist to guide the management of in-breast tumors that can produce physical and emotional discomfort in the setting of metastatic disease. We evaluated the morbidity of local therapy (LT) among patients with locally advanced metastatic breast cancer. Methods Patients with de novo T4M1 breast cancer diagnosed between 2005 and 2011 were identified from the SEER–Medicare database. We assessed receipt of care for loco-regional morbidity before and after LT. Results Among 3660 patients with T4M1 disease, 1558 (43%) underwent LT [surgery (19%), radiation (15%), both (9%)]. Before LT, few patients were reported to have loco-regional morbidity (7.9% vs. 6.7% for no LT, P = 0.17). Following LT, patients were reported to have more loco-regional morbidity than patients who did not have LT (22.6% vs. 7.9%). More patients without baseline loco-regional morbidity were reported to have received care for loco-regional morbidity documented after LT compared to baseline loco-regional morbidity reported in patients without LT (19.9% vs. 6.3%, P < 0.001). Conclusions The need to address loco-regional morbidity is relatively infrequent among patients with T4M1 disease who do not undergo LT. Receipt of care for loco-regional morbidity was higher following LT. For patients without existing loco-regional morbidity, risks of LT may outweigh potential benefits.