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Breast cancer treatment approaches for older patients often differ from those provided to younger individuals. This variation has been attributed to the higher prevalence of other health conditions in older adults, which increases the risk of mortality from causes other than cancer. On the other hand, older women are less likely to undergo breast cancer surgery and more likely to receive hormone therapy as the primary treatment (Giordano et al., 2005). However, this method has been associated with lower survival rates compared to immediate surgery and is generally suggested only for patients expected to live less than five years (Tesarova, 2013). This structured review aims to critically analyze existing literature on the post-surgical survival rates of women aged over 50 years in London who have undergone treatment for breast cancer. In terms of the demographic's unique physiological and social characteristics, understanding these survival rates is crucial for healthcare planning and patient counseling.
In older women, mastectomy without whole-breast irradiation when comparing these options to treatments provided to women aged 51-65 years (Kunkler et al., 2023). The appropriateness of favoring mastectomy in older patients is uncertain in terms of considering the increased risk of postoperative complications (POCs) and the higher incidence of frailty among this age group (de Boniface, Szulkin and Johansson, 2022).
Breast cancer is the leading type of cancer among women globally. It has been representing 11.7% of all new cancer cases in 2020 as reported by the American Cancer Society (ACS). In the United States, it is identified that 13% of women will experience breast cancer at some point. There has been a gradual increase in breast cancer cases in the U.S. and it has also been rising by 0.5% annually between 2008 and 2017.
For more understanding kindly refer to old student’s research proposal. Survival rates following surgical intervention provide critical insights into the effectiveness of breast cancer treatment strategies. They are influenced by a variety of factors, including the type and stage of cancer, the specific surgical procedure performed, and patient health at the time of surgery. For older women, these rates are also affected by age-related physiological changes. The National Cancer Institute forecasts that around 281,550 women will be diagnosed and approximately 43,600 will succumb to the disease in 2021. Despite this, mortality rates have significantly decreased by 41% between 1989 and 2018 due to advancements in detection and treatment (Healthline, 2020).
Survival rate is a key metric in assessing breast cancer treatment effectiveness, reflecting the percentage of people surviving the disease for a certain time after diagnosis. Factors influencing survival rates include age, race, stage at diagnosis, tumor size, hormonal receptor status, and type of treatment. Particularly, stage and age at diagnosis are critical in determining survival rates. Globally, 5-year survival rates vary significantly, being over 80% in developed countries, around 60% in middle-income countries, and below 40% in low-income countries. In the United States, the 5-year relative survival rate from 2001 to 2007 ranged from 99% for localized cancer to 23% for metastatic cancer (Maajani et al., 2019). On the other hand, the highest relative survival rates have been observed at the age of 50, decreasing with age.
The discovery that larger tumor size in ductal carcinoma in situ (DCIS) has been linked to higher mortality from subsequent invasive breast cancer is novel and requires validation through further research before determining a cause-and-effect relationship (Anders et al., 2009). It is identified that the DCIS is identified through screening. However, a smaller, regional study from the West Midlands in England indicated that the risk of later invasive breast cancer was greater when DCIS was diagnosed outside of the National Health Service Breast Screening Programme (NHSBSP). It has also been implied that the rates of invasive breast cancer and related mortality might be underestimated in our study compared to cases of DCIS not found through screening (Maajani et al., 2019).
The methodology and treatment for breast cancer are rapidly evolving. Innovations in surgery, adjuvant therapies and personalized medicine have changed the landscape of breast cancer management (de Boniface, Szulkin and Johansson, 2022). However, it is unclear how uniformly these advancements have been adopted or benefited the older population in London. Previous studies cannot reflect the current state of medical practice and there is an ongoing debate about the best surgical options for older women due to their unique risk profiles.
When planning this SLR, extensive preliminary searches were conducted in databases like PROSPERO, Cochrane Library and Medline to ensure the novelty and necessity of this review. These databases are renowned for their comprehensive records of systematic reviews and clinical trials. The search strategy included terms related to breast cancer, post-surgical outcomes, survival rates and older women and it has applied filters for recency to capture the latest research (Xie et al., 2022). A thorough search strategy was employed, using specific keywords and phrases related to breast cancer, post-surgical outcomes, survival rates, and older women, combined with terms specific to London's demographic and healthcare context.
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Research Aim
To assess the post-surgical survival rates of women over 50 with breast cancer in London through a systematic literature review.
Objectives
This involves a comprehensive collection and examination of data from various studies focused on women over 50 in London who have undergone surgical treatment for breast cancer. The analysis will look at survival rates, as well as any recurrent patterns or trends related to specific types of surgical interventions. The study aims to identify gaps in the current knowledge and provide recommendations for healthcare policies, patient management strategies, and areas for future research focused on improving post-surgical outcomes for this demographic. By contrasting the survival outcomes of the older demographic with those of younger women treated for breast cancer in London.
A quantitative systematic literature review (QSLR) has been compiling quantitative data from multiple research studies to provide a comprehensive and objective assessment of the evidence on a specific question. This type of review is particularly useful in healthcare to aggregate outcomes from various studies to inform clinical practice and policy-making. The aim to assess post-surgical survival rates in women over 50 with breast cancer in London necessitates a quantitative approach to accurately measure and compare outcomes across studies (Aylwin, 2023). QSLR is ideal for summarizing survival rates, treatment efficacy and other numerical data relevant to this population.
Systematic literature review has been focusing on post-surgical survival rates in women over 50 with breast cancer in London. It has chosen array of databases will be utilized to ensure comprehensive coverage of relevant literature. Medline will serve as the primary source for biomedical literature and it has been offering extensive insights into clinical medicine and healthcare systems pertinent to breast cancer treatments and outcomes (Lodge and Corbex, 2011). The Cochrane Library will complement this with high-quality systematic reviews and clinical trials and it is renowned for their rigor in evidence-based healthcare. To avoid redundancy and ensure the novelty of the review, PROSPERO will be consulted for registered systematic reviews in progress. EMBASE will be included for its strong coverage of drug and pharmaceutical research, crucial for understanding treatment efficacies and side effects. Web of Science will broaden the scope with its extensive citation network and multidisciplinary coverage and it has also been ensuring no significant study is overlooked (Pranckut?, 2021). On the other hand, if the review's scope extends to psychological aspects of cancer treatment and survivorship and PsycINFO will provide comprehensive literature on psychology and related fields. This strategic selection of databases is designed to ensure a thorough and authoritative compilation of literature. It has also been reflecting the latest and most relevant findings in the field of breast cancer treatment and survivorship for older women in London.
Search Strategy
A wide range of databases will be accessed to ensure comprehensive literature retrieval. Primary databases will include:
Medline: A leading biomedical database providing extensive coverage of medical literature.
Cochrane Library: Known for its high-quality systematic reviews and clinical trials.
PROSPERO: An international database of prospectively registered systematic reviews in health and social care.
Other databases may include Embase, Web of Science, and PsycINFO, depending on the scope and need for additional literature in psychological or social domains related to breast cancer treatment and survivorship.
A robust set of keywords and Medical Subject Headings (MeSH) will be developed to capture the relevant studies effectively. The keywords will be used in various combinations and will include:
Breast Cancer: Including "malignant neoplasm of breast," "breast carcinoma," "breast tumor."
Surgical Treatment: Including "mastectomy," "breast-conserving surgery," "lumpectomy," "oncoplastic surgery."
Post-Surgical Survival: Including "survival rate," "mortality," "long-term survival," "recurrence."
Women Over 50: Including "older women," "aging," "postmenopausal."
London: Including "Greater London," "urban health," and possibly names of specific hospitals or health services.
These terms will be adjusted and combined using Boolean operators and adapted for each database's specific syntax and capabilities.
Search Filters
To ensure the retrieval of the most relevant and up-to-date information, several filters will be applied:
Study Type: The search will focus on quantitative studies, particularly randomized controlled trials, cohort studies, and case-control studies.
Publication Date: To ensure currency, the search will typically be limited to studies published in the last 15-20 years.
Geographical Focus: If applicable, filters or additional keywords will focus on London or comparable urban settings to ensure the relevance of the data to the target population.
Language: Limited to English to ensure the review team can thoroughly assess and understand the studies.
The search will be restricted to studies published in English due to language capabilities and to ensure a certain level of study quality and accessibility. The focus will be on peer-reviewed journals as they are likely to contain rigorously vetted and high-quality research. However, conference proceedings or grey literature can be considered if they provide significant data or insights relevant to the research question.
Inclusion and Exclusion Criteria
| Criteria | Inclusion | Exclusion |
| Population | Women over 50 years old | Studies focusing on populations under 50 years old |
| Diagnosed with breast cancer | Studies not specifically addressing breast cancer | |
| Residing in or treated in London | Studies focusing on populations outside of London or without clear geographical delineation | |
| Intervention | Surgical treatments, including but not limited to mastectomy, breast-conserving surgery, and reconstruction | Non-surgical treatments such as chemotherapy, radiation therapy, unless part of a comparative study |
| Studies comparing different types of surgical interventions | ||
| Comparison | Different types of surgical interventions | Studies without a clear comparative aspect |
| No intervention or different forms of medical treatments as comparators | ||
| Outcome | Primary: Post-surgical survival rates (e.g., 1-year, 5-year, 10-year survival) | Studies not reporting specific survival rates or related outcomes |
| Secondary: Quality of life, recurrence rates, post-operative complications | Non-relevant secondary outcomes | |
| Study Design | Randomized controlled trials (RCTs) | Poorly designed or non-peer reviewed studies |
| Cohort studies | ||
| Case-control studies | ||
| High-quality registry and database studies | ||
| Time Frame | Studies published within the last 15-20 years to ensure the relevance and currency of the data | Outdated studies or those not reflecting current or recent treatment protocols |
| Language | Studies published in English | Studies not available in English |
| Publication Type | Peer-reviewed journals | Grey literature, editorials, opinion pieces unless they provide significant data or insights |
| Component | Description |
| P (Population) | Women over 50 years of age diagnosed with breast cancer residing in or treated in London. |
| I (Intervention) | Surgical treatments for breast cancer which may include mastectomy, breast-conserving surgery and reconstruction. |
| C (Comparison) | Comparison between different types of surgical interventions, or comparison with a baseline or no intervention. |
| O (Outcome) | Primary Outcome: Post-surgical survival rates (1-year, 5-year, 10-year, etc.). Secondary Outcomes can include quality of life post-surgery, recurrence rates and post-operative complications. |
The literature search strategy for assessing post-surgical survival rates in women over 50 with breast cancer in London is a critical component of the systematic literature review. It involves a comprehensive and systematic approach to identifying all relevant studies that meet the predetermined inclusion and exclusion criteria (Titler, 2018). Below is a detailed explanation of the proposed search strategy, including the rationale behind each step and critical discussion on the processes involved.
The literature search will commence with the identification and utilization of several key databases, each chosen for its relevance and scope:
Medline (via PubMed or Ovid): As a primary source of biomedical literature, it offers extensive coverage of various medical fields and is crucial for retrieving high-quality clinical research.
Cochrane Library: Known for systematic reviews and clinical trials, it's an essential database for evidence-based medicine.
PROSPERO: Consulting this database ensures the uniqueness of the systematic review by avoiding duplication and enhancing transparency.
EMBASE: This is included for its strong coverage, especially in pharmaceutical and drug-related research.
Web of Science: Offers a broad range of subjects and citation searching, providing a comprehensive view of the literature.
PsycINFO: If considering psychological aspects post-surgery, this database provides extensive coverage of psychology and related fields.
A structured approach will be employed to develop a robust set of search terms. This will include:
Medical Subject Headings (MeSH) and Keywords: Terms like "breast cancer," "surgical treatment," "survival rate," "older women," and "London" will be combined with Boolean operators to ensure a comprehensive search. Tailoring these terms to each database's specific indexing system will maximize retrieval efficiency.
Synonyms and Variations: Acknowledging the diversity in terminology, synonyms and variations of keywords will be included to ensure broad coverage.
To refine the search and ensure relevance and manageability:
Publication Date: Limiting to the last 5 from 2018 to 2023 years to focus on contemporary treatment methods and outcomes.
Language: Restricted to English to ensure that the team can thoroughly understand and assess the studies.
Study Type: Focusing on quantitative studies, particularly randomized controlled trials, cohort studies, and case-control studies for their relevance to the research questions and objectives.
It involves:
Preliminary Search: A preliminary search to familiarize with the topic, identify relevant keywords, and refine the search strategy.
Record Keeping: Detailed records of search strategies, including databases, search terms, and the number of results, will be maintained for reproducibility and transparency.
Screening Titles and Abstracts: Initially, titles and abstracts will be screened to identify studies that potentially meet the inclusion criteria.
Full-text Screening: Full texts of these studies will be reviewed to confirm eligibility.
The choice of databases ensures comprehensive and multidisciplinary coverage, crucial for a topic that spans medical, surgical, and demographic fields (Stafie et al., 2023). The use of both MeSH terms and keywords aims to balance specificity with breadth and it has also been acknowledging the variability in how different databases index literature. Limiting the search to the English language and the last 15-20 years of publication are practical considerations, reflecting the team's linguistic capabilities and the desire to focus on modern treatment paradigms. While these limitations might exclude some relevant studies, they are necessary to ensure a focused and manageable review within the scope of current clinical practices. The exclusion of grey literature, such as conference abstracts and unpublished studies, is a limitation that might lead to publication bias, as studies with positive results are more likely to be published in peer-reviewed journals (Stafie et al., 2023). However, focusing on peer-reviewed literature is a common practice in systematic reviews to ensure the quality and reliability of the included studies.
Boolean operators such as AND, OR, and NOT will be critical in effectively combining search terms to retrieve relevant literature. The operator AND will be used to narrow the search by combining terms that must all be present in the retrieved articles, such as "breast cancer" AND "surgical treatment" AND "women over 50." This ensures that only studies relevant to all aspects of the research question are retrieved. The OR operator will be used to broaden the search to include synonyms or related terms, for example, "mastectomy OR breast-conserving surgery," capturing the full range of surgical treatments considered in the review (Eriksen and Frandsen, 2018). The NOT operator might be used sparingly to exclude particular terms or irrelevant aspects, ensuring the specificity of the search results.
The search strategy will be guided by the PICO framework and it has been ensuring a focused and structured approach. This involves defining specific terms related to the Population women over 50 with breast cancer, Intervention surgical treatments, Comparison different types or absence of surgical treatments, and Outcome (post-surgical survival rates) (Eriksen and Frandsen, 2018). The PICO framework will ensure a comprehensive and systematic search tailored to the specific research question.
The inclusion and exclusion criteria are justified based on the need to focus the review on the most relevant and high-quality studies. By restricting to women over 50, the review targets a demographic with unique treatment needs and outcomes (Sozen, Ozisik and Calik Basaran, 2017). Focusing on surgical treatments allows for a detailed exploration of the most common and impactful interventions for breast cancer. Limiting to studies published in English and within the last 15-20 years ensures that the review is manageable and reflects current practice. Excluding non-quantitative studies or those not directly addressing the research question ensures the relevance and quality of the data synthesized.
Furthermore, patients are more undergo a mastectomy and less likely to receive or even opt for breast reconstruction. This is thought to be due to lower demand from patients and surgeons' beliefs about the increased risk of postoperative complications in older patients. The preference for mastectomy may also be driven by the desire to reduce the need for additional treatments like radiotherapy or a second surgery.
Initial Screening: Titles and abstracts of retrieved articles will be screened against the inclusion and exclusion criteria to identify potentially relevant studies. This will be done by at least two independent reviewers to minimize the risk of bias and error.
Full-Text Review: Full texts of the potentially relevant articles will then be obtained and assessed in detail by the same independent reviewers. Any disagreements will be resolved through discussion or consultation with a third reviewer.
Final Inclusion: Studies that meet all the inclusion criteria upon full-text review will be included in the review. The reasons for excluding articles at this stage will be recorded to ensure transparency and allow for the assessment of potential selection bias.
The systematic literature review on post-surgical survival rates in women over 50 with breast cancer in London will critically employ the Newcastle-Ottawa Scale (NOS) to ensure a rigorous quality assessment of the included observational studies. This scale is a preferred tool due to its structured approach in assessing key aspects of study quality, including the selection of study groups. The NOS's star system allows for a nuanced evaluation and it has been providing a semi-quantitative score that reflects the overall methodological strength of each study (Kolaski, Lynne Romeiser Logan and Ioannidis, 2023). By employing two independent reviewers for each study, the review aims to mitigate bias and enhance the reliability of the quality assessment process. While quality scores will significantly inform the review's analysis and discussion, studies will not be excluded solely on quality grounds, ensuring a comprehensive evidence base (Means et al., 2010). This balanced approach allows for a detailed understanding of the field, acknowledging the variations in study quality while extracting valuable insights from each piece of research. The inclusion of the NOS in the appendix will offer transparency and clarity on the assessment criteria, reinforcing the review's commitment to methodological rigor and evidence-based conclusions.
A structured quality assessment of primary research studies will be conducted using the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies. These tools are selected for their comprehensive criteria that critically evaluate various aspects of studies, including design, methodology, and ethical considerations. Each study will be rigorously appraised and scored based on these checklists and only those meeting a predefined quality threshold will be included. This inclusion/exclusion criterion is crucial to maintain the integrity and reliability of the review's findings. High-quality studies tend to offer more reliable and valid results, directly impacting the conclusions drawn from the review. By systematically documenting each step of the appraisal process and providing clear justifications for the inclusion or exclusion of each study, the review will uphold transparency and reproducibility standards. Incorporating these rigorous quality assessments ensures that the review's conclusions are based on the most robust and relevant evidence available.
In conducting the systematic literature review on post-surgical survival rates in women over 50 with breast cancer in London, a tailored data extraction tool will be utilized, derived from the Cochrane Collaboration's Data Collection Form for Intervention Reviews. This standardized form will be adapted to precisely capture essential information such as study details, participant demographics, specifics of surgical interventions, and key outcomes related to survival rates, quality of life, and any complications. The focus on specific data items like age, type of surgical treatment, and survival intervals is intentional. Furthermore, it has been ensuring the extracted information directly contributes to understanding and comparing surgical outcomes in the target population (Ehrenstein et al., 2019). Two independent reviewers will employ this adapted form to extract data from each study, mitigating potential biases and enhancing the accuracy of the collected data. The use of a robust, systematic data extraction process underpins the reliability and depth of the review and it has been ensuring that subsequent analyses and conclusions are well-founded and it has been contributing to a nuanced understanding of post-surgical outcomes in older women with breast cancer.
In analyzing data for the systematic literature review on post-surgical survival rates in women over 50 with breast cancer in London, a methodical approach will be employed. On the other hand, data will be extracted using a standardized form and assessed for quality using established tools tailored to study designs (Kim et al., 2015). The core of the analysis will involve both a narrative synthesis to describe the scope and nature of the evidence and a meta-analysis to statistically pool survival rates and other outcomes through using models based on detected heterogeneity. Subgroup and sensitivity analyses will further refine the findings and it has also been ensuring they are robust and nuanced. Throughout, efforts will be made to present the findings clearly and to discuss them in the context of existing literature, addressing any limitations and heterogeneity. The ultimate goal is to provide a comprehensive, reliable, and insightful synthesis of the evidence and it has been guiding future research and clinical practice in treating this demographic (Titler, 2018).
| Data Item | Description | Rationale for Inclusion |
| Study Reference | Author(s), Year of Publication, Journal | To identify the study and facilitate further referencing. |
| Study Design | Type of study (e.g., RCT, cohort study) | To assess the methodological approach and quality of evidence. |
| Sample Size | Number of participants | To understand the scope and statistical power of the study. |
| Participant Demographics | Age, Ethnicity, Other relevant demographics (e.g., comorbidities) | To ensure the study population is representative of the target group. |
| Location | Specifics about the location, such as urban/rural setting, healthcare facility in London | To confirm relevance to the geographical focus of the review. |
| Intervention Details | Type of surgery (e.g., mastectomy, breast-conserving surgery), any additional treatments | To understand the specific treatments being assessed and compare different types. |
| Outcome Measures | Primary: Post-surgical survival rates (e.g., 1-year, 5-year survival), Secondary: Quality of life, Complication rates | To directly assess the main research question and related factors. |
| Key Findings | Main results related to the outcomes of interest | To summarize the evidence for synthesis and comparison. |
| Quality Assessment | Score or assessment from quality assessment tool (e.g., stars from NOS) | To weigh the evidence based on the quality and risk of bias of the study. |
Timetable
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The results of the systematic literature review on post-surgical survival rates in women over 50 with breast cancer in London will be disseminated through multiple channels. Primarily, the review will be submitted to a peer-reviewed medical or public health journal specializing in oncology or geriatric medicine for publication. Additionally, findings will be presented at relevant academic conferences and symposiums. To reach a broader audience, including healthcare professionals and public health policymakers a summary of the findings will be shared on professional networks and platforms. If applicable, results will also be shared with patient advocacy groups and healthcare organizations in London to inform and enhance local breast cancer treatment protocols and patient care strategies.
References
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